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Methylene Blue for Postcardiopulmonary Bypass Vasoplegic Syndrome: A Cohort Study

BACKGROUND: Methylene blue (MB) has been used to treat refractory hypotension in a variety of settings. AIMS: We sought to determine whether MB improved blood pressure in postcardiopulmonary bypass (CPB) vasoplegic syndrome (VS) in a complex cardiac surgery population. Furthermore, to determine vari...

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Autores principales: Mazzeffi, Michael, Hammer, Benjamin, Chen, Edward, Caridi-Scheible, Mark, Ramsay, James, Paciullo, Christopher
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5408522/
https://www.ncbi.nlm.nih.gov/pubmed/28393777
http://dx.doi.org/10.4103/aca.ACA_237_16
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author Mazzeffi, Michael
Hammer, Benjamin
Chen, Edward
Caridi-Scheible, Mark
Ramsay, James
Paciullo, Christopher
author_facet Mazzeffi, Michael
Hammer, Benjamin
Chen, Edward
Caridi-Scheible, Mark
Ramsay, James
Paciullo, Christopher
author_sort Mazzeffi, Michael
collection PubMed
description BACKGROUND: Methylene blue (MB) has been used to treat refractory hypotension in a variety of settings. AIMS: We sought to determine whether MB improved blood pressure in postcardiopulmonary bypass (CPB) vasoplegic syndrome (VS) in a complex cardiac surgery population. Furthermore, to determine variables that predicted response to MB. SETTING AND DESIGN: This was conducted in a tertiary care medical center; this study was a retrospective cohort study. MATERIALS AND METHODS: Adult cardiac surgery patients who received MB for post-CPB VS over a 2-year period were studied. Mean arterial blood pressure (MAP) and vasopressor doses were compared before and after MB, and logistic regression was used to model which variables predicted response. RESULTS: Eighty-eight patients received MB for post-CPB VS during the study period. MB administration was associated with an 8 mmHg increase in MAP (P = 0.004), and peak response occurred at 2 h. Variables that were associated with a positive drug response were deep hypothermic circulatory arrest during surgery and higher MAP at the time of drug administration (P = 0.006 and 0.02). A positive response had no correlation with in-hospital mortality (P = 0.09). CONCLUSIONS: MB modestly increases MAP in cardiac surgery patients with VS. Higher MAP at the time of drug administration and surgery with deep hypothermic circulatory arrest predict a greater drug response.
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spelling pubmed-54085222017-05-08 Methylene Blue for Postcardiopulmonary Bypass Vasoplegic Syndrome: A Cohort Study Mazzeffi, Michael Hammer, Benjamin Chen, Edward Caridi-Scheible, Mark Ramsay, James Paciullo, Christopher Ann Card Anaesth Original Article BACKGROUND: Methylene blue (MB) has been used to treat refractory hypotension in a variety of settings. AIMS: We sought to determine whether MB improved blood pressure in postcardiopulmonary bypass (CPB) vasoplegic syndrome (VS) in a complex cardiac surgery population. Furthermore, to determine variables that predicted response to MB. SETTING AND DESIGN: This was conducted in a tertiary care medical center; this study was a retrospective cohort study. MATERIALS AND METHODS: Adult cardiac surgery patients who received MB for post-CPB VS over a 2-year period were studied. Mean arterial blood pressure (MAP) and vasopressor doses were compared before and after MB, and logistic regression was used to model which variables predicted response. RESULTS: Eighty-eight patients received MB for post-CPB VS during the study period. MB administration was associated with an 8 mmHg increase in MAP (P = 0.004), and peak response occurred at 2 h. Variables that were associated with a positive drug response were deep hypothermic circulatory arrest during surgery and higher MAP at the time of drug administration (P = 0.006 and 0.02). A positive response had no correlation with in-hospital mortality (P = 0.09). CONCLUSIONS: MB modestly increases MAP in cardiac surgery patients with VS. Higher MAP at the time of drug administration and surgery with deep hypothermic circulatory arrest predict a greater drug response. Medknow Publications & Media Pvt Ltd 2017 /pmc/articles/PMC5408522/ /pubmed/28393777 http://dx.doi.org/10.4103/aca.ACA_237_16 Text en Copyright: © 2017 Annals of Cardiac Anaesthesia http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Original Article
Mazzeffi, Michael
Hammer, Benjamin
Chen, Edward
Caridi-Scheible, Mark
Ramsay, James
Paciullo, Christopher
Methylene Blue for Postcardiopulmonary Bypass Vasoplegic Syndrome: A Cohort Study
title Methylene Blue for Postcardiopulmonary Bypass Vasoplegic Syndrome: A Cohort Study
title_full Methylene Blue for Postcardiopulmonary Bypass Vasoplegic Syndrome: A Cohort Study
title_fullStr Methylene Blue for Postcardiopulmonary Bypass Vasoplegic Syndrome: A Cohort Study
title_full_unstemmed Methylene Blue for Postcardiopulmonary Bypass Vasoplegic Syndrome: A Cohort Study
title_short Methylene Blue for Postcardiopulmonary Bypass Vasoplegic Syndrome: A Cohort Study
title_sort methylene blue for postcardiopulmonary bypass vasoplegic syndrome: a cohort study
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5408522/
https://www.ncbi.nlm.nih.gov/pubmed/28393777
http://dx.doi.org/10.4103/aca.ACA_237_16
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