Document Detail


Methylene blue in the treatment of vasoplegia following severe burns.
MedLine Citation:
PMID:  18354304     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Vasoplegia resulting from severe burns may persist despite adequate fluid resuscitation and treatment with norepinephrine (NE), vasopressin (VP), and steroids. The adenylate cyclase inhibitor methylene blue (MB), currently used in the burn patient to treat methemoglobinemia, has been used to treat vasoplegia after cardiopulmonary bypass. We report the case of MB infusion in two burn patients refractory to NE. The patients had severe burns, 95 and 80% TBSA not responding to conventional treatment. Fluid requirements were estimated according to Parkland formula and then to maintain a urinary output of 30-50 ml/hr. Patient #1, 95% TBSA, was adrenally insufficient and was receiving steroids according to the Annane protocol, as well as VP at 0.2 U/min. His NE requirements were 55 mcg/kg/min. Patient #2, 80% TBSA, was receiving 20 mcg/kg/min of NE. Circulatory failure was defined as inability to maintain mean arterial pressure >70 mm Hg. Hemodynamic and physiologic parameters were measured before and after infusion of a single dose of 2 mg/kg of MB. Both patients showed dramatic improvements in their shock after MB. Patient #1 had an initial reaction within 30 minutes and reached peak effect at 1 hour. His NE requirements decreased to 0.2 mcg/kg/min and VP decreased to 0.04 U/min. Patient #2 showed effects within 15 minutes of the infusion and by 2 hours the NE was stopped. No adverse side effects were noted in either of the two patients. The fact that MB successfully reversed refractory vasoplegia after severe burns suggests a new tool for treating a small subgroup of patients who exhibit persistent vasoplegia from their burn injury. A controlled randomized trial is needed to test its effects on a large number of patients and graft survival.
Authors:
Amín D Jaskille; James C Jeng; Marion H Jordan
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Journal of burn care & research : official publication of the American Burn Association     Volume:  29     ISSN:  1559-047X     ISO Abbreviation:  -     Publication Date:    2008 Mar-Apr
Date Detail:
Created Date:  2008-04-08     Completed Date:  2008-08-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101262774     Medline TA:  J Burn Care Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  408-10     Citation Subset:  IM    
Affiliation:
Department of Surgery, Burn Center, Washington Hospital Center, Washington DC 20010, USA.
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MeSH Terms
Descriptor/Qualifier:
Burns / complications*
Enzyme Inhibitors / adverse effects,  therapeutic use*
Fatal Outcome
Fluid Therapy
Humans
Hypotension / drug therapy*,  etiology
Male
Methylene Blue / adverse effects,  therapeutic use*
Middle Aged
Norepinephrine / adverse effects,  therapeutic use
Treatment Failure
Vasoconstrictor Agents / adverse effects,  therapeutic use
Chemical
Reg. No./Substance:
0/Enzyme Inhibitors; 0/Vasoconstrictor Agents; 51-41-2/Norepinephrine; 61-73-4/Methylene Blue

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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