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Assessing the Hemodynamic Changes and Clinical Effects of Methylene Blue in Patients With Septic Shock FREE TO VIEW

Akshay Muralidhar, MD; Daniel Djondo, MD; Erin Mancl, PharmD; Stephanie Kliethermes, PhD; Beverly Gonzalez, MMSc; Shankho Ganguli, MD; Bassel Sayegh, MD; Kevin Simpson, MD
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Loyola University Medical Center, Chicago, IL

Chest. 2015;148(4_MeetingAbstracts):347A. doi:10.1378/chest.2270067
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SESSION TITLE: Sepsis and Shock Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Studies in the past have shown hemodynamic improvements after methylene blue (MB) administration in septic shock patients. However, much of this data was collected prior to wide-spread implementation of early goal directed therapy for septic shock, and before the implementation of current guidelines. The purpose of this study is to retrospectively review the hemodynamic effects of MB in patients treated for septic shock in a single ICU in recent years, and secondarily to characterize changes in oxygen requirements and other markers of disease

METHODS: A retrospective review was performed on patients in septic shock and treated with a MB infusion from 2012 to 2014. Mean arterial blood pressure (MAP), systolic (SBP) and diastolic blood pressures (DBP) and dosages of norepinephrine (NE) and vasopressin (VASO) were recorded to the nearest 24, 6, 3, 1 hour(s), and 30 and 15 minutes before and after initiation of MB administration. Arterial oxygen pressures (PaO2), fraction of inspired oxygen (FiO2), and other laboratory values were collected in a similar format as well

RESULTS: A total of 20 different instances of methylene blue administration in 18 patients were identified. After controlling for MAP, the dosage of NE increased, on average, by 0.06 mcg/kg/min (p=0.06) before MB and decreased by 0.03 mcg/kg/min for every hour increase (p<0.001) after MB. These changes were significantly different before and after MB administration (p=0.007). A similar decrease in dosage post MB was noted after controlling for SBP (p=0.009). After adjusting for MAP, the odds of VASO use before MB are higher than the odds of VASO use after MB (p=0.004). Similar results are noted when controlling individually for SBP and DBP. There was no difference in mixed venous oxygen saturation, the PaO2/FiO2 ratio and lactate levels with MB use

CONCLUSIONS: Administration of MB significantly decreases the use of vasopressor medications suggesting hemodynamic improvement in patients with septic shock. However, oxygen use and some markers of shock are not changed significantly with MB administration in this study

CLINICAL IMPLICATIONS: The hemodynamic effect of MB in septic shock is suggested by improving vasopressor requirements in the current management of septic shock. Future directions of analysis include studying specific parameters in this population that may determine variability in response to MB as well as understanding the effect of MB on non hemodynamic characteristics in patients involving larger numbers and a prospective study design

DISCLOSURE: The following authors have nothing to disclose: Akshay Muralidhar, Daniel Djondo, Erin Mancl, Stephanie Kliethermes, Beverly Gonzalez, Shankho Ganguli, Bassel Sayegh, Kevin Simpson

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