Document Detail


Methylene blue reduces mortality and morbidity in vasoplegic patients after cardiac surgery.
MedLine Citation:
PMID:  14759425     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The discovery of nitric oxide as mediator in cardiac postoperative vasoplegia encourages the use of inhibitory drugs such as methylene blue. This drug has been used with favorable results in isolated cases. The purpose of this article is to analyze the incidence of the postoperative vasoplegic syndrome, to consider its prognosis, and to evaluate the effect of intravenous methylene blue on mortality. METHODS: Cardiac surgery patients were consecutively included. Vasoplegic syndrome was defined by the presence of the following five criteria: (1) hypotension, (2) low filling pressures, (3) high or normal cardiac index, (4) low peripheral resistance, and (5) vasopressor requirements. Those with vasoplegia were randomized to receive 1.5 mg/Kg of methylene blue or a placebo. A p value less than 0.05 was considered significant. RESULTS: Six hundred thirty eight cardiac surgery patients were consecutively included in this study. Fifty-six of these patients fulfilled vasoplegia criteria (8.8%) resulting in higher mortality (10.7% or 6 of 56 patients vs 3.6% or 21 of 582 patients; p value = 0.02). Those treated with methylene blue showed morbidity and mortality reductions (0% versus 21.4% or 6 of 28 patients; p value = 0.01). The duration of the vasoplegic syndrome was shorter in those patients treated with the drug, lasting less than 6 hours in all patients. Patients in the control group showed a slower recovery, lasting more than 48 hours in 8 patients (p value = 0.0007). CONCLUSIONS: Vasoplegic postoperative syndrome was seen in 8.8% of all patients. Outcome in patients with vasoplegia was worse with increased morbidity and mortality. The use of methylene blue reduced the high mortality in this population.
Authors:
Ricardo L Levin; Marcela A Degrange; Gustavo F Bruno; Carlos D Del Mazo; Daniel J Taborda; Jorge J Griotti; Fernando J Boullon
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Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  77     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2004 Feb 
Date Detail:
Created Date:  2004-02-04     Completed Date:  2004-03-17     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  496-9     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiovascular Surgery, Navy Hospital, French Hospital, Swiss-Argentine Clinic, Argentine Institute of Diagnosis and Saint Elizabeth Clinic, Buenos Aires, Argentina. rllevin@intramed.net.ar
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MeSH Terms
Descriptor/Qualifier:
Cardiopulmonary Bypass*
Cause of Death
Coronary Disease / surgery*
Enzyme Inhibitors / administration & dosage*
Female
Heart Valve Diseases / surgery*
Hemodynamics / drug effects
Humans
Hypotension / drug therapy*,  mortality
Infusions, Intravenous
Male
Methylene Blue / administration & dosage*
Middle Aged
Nitric Oxide / antagonists & inhibitors
Postoperative Complications / drug therapy*,  mortality
Risk Factors
Survival Rate
Systemic Inflammatory Response Syndrome / drug therapy*,  mortality
Vascular Resistance / drug effects
Chemical
Reg. No./Substance:
0/Enzyme Inhibitors; 10102-43-9/Nitric Oxide; 61-73-4/Methylene Blue

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


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