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2001, Number 2

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Cir Cir 2001; 69 (2)

Treatment of early phases of septic shock with methylene blue

Carrillo-Espe R

Language: Spanish
References: 33
Page: 68-73
PDF size: 92.59 Kb.


ABSTRACT

Introduction: Nitric oxide produces vasodilatation and myocardial depression in septic shock that is associated to tisular hypoperfusion and multiorganic dysfunction. Objective: To evaluate the effect of methylene blue, a potent guanylate cyclase blocker, to revert early phases of septic shock. Patients and method: We carried out an experimental clinical-pharmacologic trial without controls. Six patients were included with early septic shock after the initial treatment with volume infusion, dobutamine, and norepinephrine had failed. In all patients, the infectious process has been controlled and organic failures have not been appeared. The initial dose of methylene blue was 2 mg/kg followed by continuous infusion of 1 mg/kg/h for 12 h. The patients were subjected to advanced hemodynamic monitoring and determination of MAP, MPP, PCP, CI, SVRI, PVRI, LVI, DO2/VO2, arterial pH, and HCO3 before the initial dose, and in the following 1, 4, 8, 12, 24, and 48 h, transthoracic echocardiography to evaluate systolic and diastolic function and methahemoglobin levels. Results: Significant increment (p‹0.05) was obtained in MAP and SVRI, as well as in the relationship between DO2/VO2, reverting the shock state, and improving the tissue perfusion, made possible quick reduction in the dose of vasopressors. Echocardiographically, we observed revertion of systolic and diastolic dysfunction. Methylene blue, a potent bloker of guanylate cyclase, is a therapeutic alternative in initial phases of septic shock when initial treatment failed infectious process was controlled, and organic failure has not get appeared.


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