Methylene blue increases myocardial function in septic shock

Cr, Daemen-Gubbels; Ph, Groeneveld; Ab, Groeneveld; Gj, van Kamp; Bronsveld, W; Lg, Thijs

doi:10.1097/00003246-199508000-00009

Cited by 108 publications

(77 citation statements)

References 24 publications

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“…Although cardiac output did not increase significantly, the increase in left ventricular stroke work in the presence of unchanged filling pressures, despite an increase in systemic vascular resistance, suggests an improvement in myocardial function following methylene blue administration. Our finding is in agreement with previous studies using methylene blue in septic shock patients (26,28). In vivo and in vitro studies have shown that exposure to endotoxin-activated macrophages, cytokines or serum from septic patients causes depressant effects on myocytes that are reversed by L-arginine analogs and methylene blue (11)(12)(13).…”

Section: Discussionsupporting

confidence: 93%

“…In experimental studies, methylene blue attenuated vasodilation and myocardial dysfunction and increased mesenteric blood flow (11,14,25). Three studies on septic shock patients have reported an increase in blood pressure and in myocardial function after a bolus infusion of methylene blue without acute toxicity (26)(27)(28). However, Gachot et al (27) reported a reduction in the arterial oxygen tension/inspired oxygen concentration (PaO 2 /FiO 2 ) ratio and an increase in arterial carbon dioxide tension (PaCO 2 ), and these side effects raise concern about the safety of methylene blue administration in patients with lung injury.…”

Section: Introductionmentioning

confidence: 99%

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Blockade of the action of nitric oxide in human septic shock increases systemic vascular resistance and has detrimental effects on pulmonary function after a short infusion of methylene blue

Weingartner

Oliveira

Sant'Anna

et al. 1999

Braz J Med Biol Res

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To investigate the role of nitric oxide in human sepsis, ten patients with severe septic shock requiring vasoactive drug therapy and mechanical ventilation were enrolled in a prospective, open, non-randomized clinical trial to study the acute effects of methylene blue, an inhibitor of guanylate cyclase. Hemodynamic and metabolic variables were measured before and 20, 40, 60, and 120 min after the start of a 1-h intravenous infusion of 4 mg/kg of methylene blue. Methylene blue administration caused a progressive increase in mean arterial pressure (60 [55-70] Arterial lactate concentration decreased from 5.1 ± 2.9 to 4.5 ± 2.1 mmol/ l, mean ± SD (P<0.05) after 60 min. Heart rate, cardiac filling pressures, cardiac output, oxygen delivery and consumption did not change. Methylene blue administration was safe and no adverse effect was observed. In severe human septic shock, a short infusion of methylene blue increases systemic vascular resistance and may improve myocardial function. Although there was a reduction in blood lactate concentration, this was not explained by an improvement in tissue oxygenation, since overall oxygen availability did not change. However, there was a significant increase in pulmonary vascular tone and a deterioration in gas exchange. Further studies are needed to demonstrate if nitric oxide blockade with methylene blue can be safe for patients with septic shock and, particularly, if it has an effect on pulmonary function.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Blockade of the action of nitric oxide in human septic shock increases systemic vascular resistance and has detrimental effects on pulmonary function after a short infusion of methylene blue

Weingartner

Oliveira

Sant'Anna

et al. 1999

Braz J Med Biol Res

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“…Invasive hemodynamic data is well documented in cases of refractory vasodilatory shock treated with methylene blue in sepsis and coronary artery bypass surgery [4,5,7]. However, these are not well documented in previous cases of refractory vasodilatory shock treated with methylene blue.…”

Section: Discussionmentioning

confidence: 99%

“…Increases in systemic vascular resistance and mean arterial pressure have been consistently described following methylene blue administration for shock due to non-poisoning causes, including vasoplegic syndrome after coronary artery bypass surgery [4] and sepsis [5][6][7]. Methylene blue, from a mechanistic standpoint, is an attractive therapy for drug-induced vasodilatory shock, though published literature includes only a small number of human case reports and animal studies [8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Improvement in Hemodynamics After Methylene Blue Administration in Drug-Induced Vasodilatory Shock: A Case Report

Laes

Williams

Cole³

2015

J. Med. Toxicol.

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Introduction The purpose of this study is to describe a case where methylene blue improved hemodynamics in a poisoned patient.Case Report This is a single case report where a poisoned patient developed vasodilatory shock following ingestion of atenolol, amlodipine, and valsartan. Shock persisted after multiple therapies including vasopressors, high-dose insulin, hemodialysis, and 20% intravenous fat emulsion. Methylene blue (2 mg/kg IV over 30 min) was administered in the ICU with temporal improvement as measured by pulmonary artery catheter hemodynamic data pre-and post-methylene blue administration. Within 1 h of methylene blue administration, systemic vascular resistance improved (240 dyn s/cm5 increased to 1204 dyn s/cm5), and vasopressor requirements decreased with maintenance of mean arterial pressure 60 mmHg. Discussion Methylene blue may improve hemodynamics in drug-induced vasodilatory shock and should be considered in critically ill patients poisoned with vasodilatory medications refractory to standard therapies.

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“…DaemenGubbels (68,1995) Non-randomized clinical trial involving MB administration in the setting of sepsis. The trial involved consecutive patients with a pulmonary catheter in place (n = 9).…”

Section: The Use Of Methylene Blue In Hypotensive Patientsmentioning

confidence: 99%