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. 2018 Mar;22(3):168-173.
doi: 10.4103/ijccm.IJCCM_494_17.

Methylene Blue for Vasoplegic Syndrome Postcardiac Surgery

Aly Makram Habib  1   2 , Ahmed Galal Elsherbeny  3   4 , Rayd Abdelaziz Almehizia  5
Affiliations

Methylene Blue for Vasoplegic Syndrome Postcardiac Surgery

Aly Makram Habib et al. Indian J Crit Care Med. 2018 Mar.

Abstract

Objectives: cardiopulmonary bypass (CPB) can be complicated by vasoplegia that is refractory to vasopressors. Methylene blue (MB) represents an alternative in such cases.

Patients and methods: Retrospective observational historical control-matched study. From 2010 to 2015, all patients who received MB for vasoplegia post-CPB were included in this study. Historical controls from the period of 2004 to 2009 were matched. End-points were the time till improvement of vasoplegia (Ti), 30-day mortality, cardiac surgical Intensive Care Unit (CSICU) morbidity, and length of stay (LOS).

Results: Twenty-eight patients were matched in both groups. There were no statistically significant differences between the two groups in demographic, laboratory data on admission, or hemodynamic profile before use of MB. Ti and time to complete discontinuation of vasopressors were statistically significant less in MB group (8.2 ± 2.6 vs. 29.7 ± 6.4, P = 0.00 and 22.6 ± 5.2 vs. 55.3 ± 9.4, P = 0.00) respectively. Mortality at day 30 was significantly higher in controls compared to MB (1 patient [3.6%] vs. 6 patients [21.4%], long rank P = 0.04). CSICU, hospital LOS, and incidence of renal failure was significantly higher in control group (12.4 ± 3.7 vs. 7 ± 1.4, P = 0.03), (19.5 ± 2.4 vs. 10.9 ± 3.2, P = 0.05) and (9 patients [32.1%] vs. 2 patients [7.1%], P = 0.04), respectively. Duration of mechanical ventilation was less in MB patients; however, did not reach statistical significance.

Conclusions: the use of MB for vasoplegia postcardiac surgery was associated with rapid recovery of hemodynamics, shorter need for vasopressors, less ICU mortality, less incidence of renal failure, and shorter LOS.

Keywords: Cardiac surgery; methylene blue; vasoplegia.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Patients included in the study
Figure 2
Figure 2
Evolution of hemodynamics over time in both groups. a: CI, cardiac index; b:MAP, mean arterial pressure; c: SVRI, systemic vascular resistance index; d: VIS, vasoactive inotropic score; e: lactate. *P < 0.05, **P < 0.01
Figure 3
Figure 3
Kaplan–Meier curve for survival in two groups
See this image and copyright information in PMC

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