• Abele Donati, Giovanna Conti, Silvia Loggi, Cristopher Münch, Rosanna Coltrinari, Paolo Pelaia, Paolo Pietropaoli, and Jean-Charles Preiser.
• Department of Medicosurgical Emergency, University of Ancona, Italy. donati@indi.it
• Crit. Care Med. 2002 Oct 1;30(10):2271-7.

ObjectiveTo assess the effects of the inhibition of guanylate cyclase, an enzyme involved in sepsis-related vascular and myocardial dysfunctions, on hemodynamic variables including blood volume and pulmonary vascular permeability during septic shock.DesignProspective, open study with repeated measurements.SettingA medicosurgical intensive care unit of a university hospital.PatientsFifteen patients with septic shock associated with persisting hypotension despite conventional treatment including fluid loading, vasopressors, and inotropes.InterventionsA fiberoptic catheter was inserted for the determination of blood and extravascular volumes by the thermal-dye double indicator technique, using indocyanine green (COLD system). A bolus dose of methylene blue (3 mg/kg) was infused intravenously over 10 mins. COLD-derived variables were recorded before methylene blue and 20 mins, 1 hr, and 2 hrs after the end of methylene blue infusion.Measurements And Main ResultsStandard hemodynamic and oxygen-derived variables; total, intrathoracic, systolic, and diastolic cardiac blood volumes; extravascular lung water; plasma osmolarity; and lactate and protein concentrations were recorded. Mean arterial and pulmonary artery pressures, systemic and pulmonary vascular resistances, and left ventricular stroke work index increased, and blood lactate transiently decreased after methylene blue (p <.05). The other variables recorded were unchanged during the 2-hr period following methylene blue infusion.ConclusionsThis study confirmed the acute vasoconstrictive and positive inotropic effects of methylene blue during septic shock. These effects were not associated with changes in blood volume, myocardial diastolic function, or pulmonary vascular permeability assessed by extravascular lung water.

36 keywords...

hide…