Use of methylene blue in patients with refractory septic shock: Impact on hemodynamics and gas exchange

Andresen, Max; Dougnac, A; Díaz, Orlando; Hernández, Giselle Riquelme; Castillo, Luis; Bugedo, Guillermo; Álvarez, Manuel; Dagnino, Jorge

doi:10.1016/s0883-9441(98)90001-6

Cited by 84 publications

(55 citation statements)

References 25 publications

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“…However, an intravenous dose of 1 mg/kg elicited increased vasoconstriction without increasing the heart rate, cardiac output, or oxygen delivery and consumption. 35 MB is absorbed through the peritoneal lining as was evidenced, in the present work, by the greenish discoloration of the rats' urine. So, remote effects on other organs may be expected, particularly if high concentrations were used.…”

Section: Discussionsupporting

confidence: 73%

Effect of methylene blue on intra-abdominal adhesion formation in rats

Mahdy

Mohamed

Elhawary

2008

International Journal of Surgery

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a b s t r a c tBackground: Adhesion formation represents an important clinical challenge in gastro-intestinal surgery. In the late era, methylene blue (MB) has been claimed to play a helping role in combating such a problem. In the present study, we investigated the effects of MB administered intraperitoneally on the surgically-induced adhesions in rats and tried to clarify whether its impact is concentration-dependent.Material & Methods: Seventy adult male Wistar rats were used. They were allocated into seven groups, ten rats each: one control, two sham-operated and four experimental ones. Peritoneal adhesions were evoked by scraping the cecal serosa in the four experimental groups which were given different concentrations of MB, intraperitoneally. The animals of the control group were similarly dealt but were given saline. The rats of the sham-operated groups were given either MB or saline but without any serosal damage.Results: After the elapse of two weeks, the resulting adhesions, inflammation and fibrosis were evaluated. In the rats treated with MB 1%, adhesions, inflammatory process and fibrosis scores were similar to those in the sham-operated rats and were significantly lower than those in all other groups.Conclusion: It could be concluded that MB, 1%, had the best anti-adhesion potential.

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Section: Discussionsupporting

confidence: 73%

Effect of methylene blue on intra-abdominal adhesion formation in rats

Mahdy

Mohamed

Elhawary

2008

International Journal of Surgery

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“…Its pharmacologic mechanism of effect and previous descriptions in sepsis literature [15][16][17] support its use in vasodilatory shock from calcium channel blocker poisoning. Septic shock is associated with excess nitric oxide production which in turn stimulates soluble guanylyl cyclase (cGMP) to increase endothelial smooth muscle relaxation [15]. Methylene blue inhibits guanylyl cyclase, resulting in less production of cGMP and subsequently decreased endothelial smooth muscle relaxation [17].…”

Section: Discussionmentioning

confidence: 59%

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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“…[3][4][5][6][7][8][9][10][11][12] Little is known about the clinical utility, optimal dose, or duration of MB administration in patients with septic shock. The relatively few reports available on the use of MB in septic shock describe relatively short infusions.…”

Section: Résumémentioning

confidence: 99%

Prolonged methylene blue infusion in refractory septic shock: a case report

Dumbarton

Minor

Yeung

et al. 2011

Can J Anesth/J Can Anesth

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Purpose Methylene blue (MB) has been advocated for the treatment of refractory hemodynamic instability in patients with septic shock. However, the use of MB infusions in septic shock is not considered standard treatment, and the available literature describes infusions of short duration, typically less than six hours. Clinical features We report a case of septic shock in a 67-yr-old male who required maximal vasopressor support with norepinephrine, epinephrine, and vasopressin. Despite standard protocols for the treatment of septic shock, the patient's hemodynamic status was refractory 80 hr post admission. However, initiation of a MB infusion resulted in the rapid restoration of hemodynamic stability and a subsequent decrease in vasopressor requirements.Multiple attempts to discontinue the MB infusion resulted in immediate and repeated increases in vasopressor requirements, necessitating a continuous infusion with a slow taper of MB for 120 hr. Ultimately, the patient survived the illness and was discharged home. We observed no adverse events that could be attributed to the use of MB. Conclusion In our patient, the use of MB resulted in hemodynamic stability unattained with standard vasopressor support. Further research is warranted on the use of MB in patients with septic shock. RésuméObjectif Le bleu de me´thyle`ne (BM) a e´te´propose´par certains chercheurs comme traitement de l'instabiliteh e´modynamique re´fractaire chez les patients en choc septique. La perfusion de BM n'est toutefois pas conside´re´e comme un traitement standard du choc septique, et la litte´rature publie´e de´crit des perfusions de courte dure´e, en ge´ne´ral de moins de six heures. É léments cliniques Nous rapportons un cas de choc septique chez un homme de 67 ans qui a eu besoin d'un soutien vasopresseur maximal avec de la nore´pine´phrine, de l'e´pine´phrine et de la vasopressine. Malgre´l'application des protocoles normalise´s pour le traitement du choc septique, l'e´tat he´modynamique du patient demeurait re´fractaire 80 h apre`s son admission. L'amorce d'une perfusion de BM a toutefois permis de re´tablir rapidement la stabilite´he´modynamique du patient et a entraıˆne´une re´duction subse´quente de ses besoins en vasopresseurs. Les nombreuses tentatives d'interruption de la perfusion de BM ont entraıˆne´des augmentations imme´diates et re´pe´te´es des besoins en vasopresseurs, c'est pourquoi une perfusion continue a`un de´bit plus bas de BM durant 120 h a e´te´mise en place. Le patient a finalement surve´cu a`la maladie et reçu son conge´de l'hôpital. Nous

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Use of methylene blue in patients with refractory septic shock: Impact on hemodynamics and gas exchange

Cited by 84 publications

References 25 publications

Effect of methylene blue on intra-abdominal adhesion formation in rats

Effect of methylene blue on intra-abdominal adhesion formation in rats

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

Prolonged methylene blue infusion in refractory septic shock: a case report

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