Methylene blue versus vasopressin in sepsis-induced vasoplegia

Mostafa ElAdawy, Ahmed S Omran

Ain-Shams Journal of Anaesthesiology 2016 9(3):319-324

Background Septic shock is one of the biggest causes of mortality in intensive care settings, and, despite all the recent advances in pharmacological and mechanical support therapies, is the second leading cause of death among ICU patients. Although vasopressors have been widely used in these situations, where keeping the hemodynamic stability is of utmost importance, a detailed study of their effects is undoubtedly needed. Objective Our study compared the effect of methylene blue (MB) in the vasoplegic situation associated with sepsis with that of vasopressin. Patients and methods We randomized 40 patients into two groups (20 patients each); patients in the first group received MB, whereas patients in the second group received vasopressin as a hemodynamic support. Results In the present study, mean arterial blood pressure was found to be significantly higher in the MB group compared with the vasopressin group, whereas within the MB group, it was significantly higher after 6 h compared with the baseline level. The systemic vascular resistance showed no difference between the two groups at the start but a marked difference only after 2 h, being higher for the MB group — that is, there was a significant decrease in the vasopressors and inotropes needed in the MB group. There was no significant difference between the two groups regarding the ICU length of stay, the central venous pressure, pulmonary artery pressure, and oxygen extraction ratio. Conclusion The use of MB in sepsis-induced refractory vasoplegic situations remains one of the salvage management strategies; however, the practice of its routine use is yet to be established and needs further investigation.

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