Background and aim: Vasoplegic syndrome (VS) is a frequent complication following cardiopulmonary bypass (CPB) requiring escalating dose of vasopressor support. The guanylate cyclase inhibitor methylene blue (MB) could be an attractive alternative treatment in such cases. This study examines the efficacy and safety of using MB compared to the commonly used norepinephrine in VS in pediatric population following CPB. Methods: Forty patients of pediatric age group who developed VS following CPB for elective corrective cardiac surgeries received 0.5 lg/kg/min norepinephrine intravenous infusion for 5 min without improvement (Time 1). Patients were randomly assigned to two equal groups. Group MB received 1.5 mg/kg methylene blue by intravenous infusion over 20 min. Group N did not receive MB. Norepinephrine infusion was continued in both groups and titrated according to the response of patients with a maximum dose of 2 lg/kg/min (Time 2). Heart rate, mean arterial pressure (MAP), central venous pressure (CVP), cardiac output (CO), cardiac index (CI), mean pulmonary artery pressure (MPAP), systemic vascular resistance (SVR) and systemic vascular resistance index (SVRI) were calculated in both groups. Side effects related to the study drug were recorded. Results: Time 2 values of norepinephrine dose were significantly lower in MB group compared to N group. Time 2 values of MAP were significantly higher in MB group compared to N group with a significant decrease in HR in MB group compared to N group. No change in the rhythm was detected in the two groups. Time 2 values of CVP were higher in MB group compared to N group. Time 2 values of CO and CI were significantly lower in MB group compared to N group and SVR and SVRI were significantly higher in MB group compared to N group. Time 2 values of MPAP were comparable in both groups and showed no significant change. No side effects from using MB were recorded as pulmonary edema and respiratory distress.

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Objective: The objective of this study was to evaluate the efficacy of using alanineglutamine (Aln-Gln) dipeptide as a supplement to control diabetes in liver transplanted patients. Patients and methods: Eighty patients aged >18 yr admitted to ICU after receiving right lobe living donor liver transplantation (LDLT), had a previous history of diabetes or had a new onset diabetes (NODM) were enrolled in this prospective randomized double blind study. Patients were randomized into two groups and assigned to receive parenterally an equal dose of amino acids either with alanyl-glutamine dipeptide in the dose of 0.5 g/kg/d (group AG) or without alanylglutamine dipeptide (control group C). This regimen started at day 1 postoperative in diabetic patients or when new onset diabetes has been diagnosed in non-diabetic and continued till day 9 with measuring the incidence of hyperglycemia, hyperglycemic episodes, total insulin requirements/ day, infectious episodes, ICU and hospital length of stay, and 6 month mortality rate. Results: The hyperglycemic episodes were significantly less in AG group patients than in control group patients (29 vs 38). Hyperglycemia requiring insulin therapy in AG group was significantly less (22 vs 28 patients). Also those who required decreasing TPN requirements were significantly lesser in the AG group (7 vs 11 patients). Insulin requirements per day in the AG group were significantly lower (53 ± 11 vs 78 ± 9 IU). The number of episodes of nosocomial infection per patient was lower in the AG group than in the control group (20 vs 28). The decrease in nosocomial infections in patients receiving AG was related mainly to a decrease in the incidence of pneumonia (7 vs 11). The ICU length of stay (LOS) was significantly lower in the AG group than in the control group (7.81 ± 2.98 vs 10.43 ± 4.67 day) Conclusion: Our study showed that using AG supplementation in liver transplanted patients who have either a history of diabetes or NODM, reduces the insulin requirements, hyperglycemic episodes, infectious events and ICU stay.

Background Management of sepsis is a time critical procedure; the consequences of improperly managed sepsis and septic shock can cause multiple organ dysfunction and death. The aim of this study was to evaluate of the role of hydrocortisone either alone or with fludrocortisone on the outcome septic shock in adults. This study was conducted on 66 patients who were assigned randomly to 3 groups each containing 22 patients. Control group had received standard therapy for sepsis, and H group had received standard therapy for sepsis plus hydrocortisone. HF group had received standard therapy for sepsis plus hydrocortisone and fludrocortisone. Results It showed that the use of corticosteroids (the hydrocortisone or the hydrocortisone plus fludrocortisone) in septic patients was associated with significant reduction in the time to wean from vasopressors and length of intensive care unit stay. Meanwhile, there were no significant effect of the mortality rate, Sepsis-Related Organ Failure Assessment (SOFA) score reduction, gastrointestinal bleeding, and superinfection as corticosteroids adverse effects between the three groups. Conclusions The corticosteroids in septic shock have significant positive impacts on some aspects in treatment of septic shock but it does not affect the mortality rate of the patients.

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