Department of Pharmacy, Cleveland Clinic, Cleveland, OH.
Department of Cardiothoracic Anesthesia, Cleveland Clinic, Cleveland, OH.
J Cardiothorac Vasc Anesth. 2022 Sep;36(9):3543-3550. doi: 10.1053/j.jvca.2022.04.003. Epub 2022 Apr 7.
To compare the hemodynamic response of methylene blue dosing regimens (bolus v bolus plus infusion) for the treatment of vasoplegia.
A retrospective cohort analysis.
A single-center academic medical center.
Patients who underwent cardiac surgery at Cleveland Clinic and received methylene blue between 2016 and 2019. Patients were excluded from the analysis if methylene blue was initiated >48 hours after surgery, if the cardiac index was <2.0 L/min/m, or if they returned to the operating room for postoperative hemorrhage.
Methylene blue bolus-only regimens versus bolus plus continuous infusion methylene blue regimens.
The primary outcome was vasopressor requirement over 48 hours (1, 3, 6, 12, 24, and 48 hours) after methylene blue initiation. Other hemodynamic outcomes evaluated included the rate of methylene blue response, mean arterial pressure (MAP), and systemic vascular resistance (SVR) values over time. In total, 44 patients were included in the analysis, 33 of whom only received a methylene blue bolus. Vasopressor requirements at baseline were 95 (95% CI: 70-122) µg/min norepinephrine equivalent (NE) in the bolus-only group and 100 (86-130) µg/min in the infusion group. Vasopressor requirements decreased at each time point in both groups and were similar throughout (hour 1 mean [95% CI] NE, bolus 79 [67-91] µg/min v bolus plus infusion 84 [63-104] µg/min; p = 0.71). MAP, SVR, and rates of methylene blue response were similar between groups at all time points. Clinical outcomes also were similar between groups.
The addition of a methylene blue continuous infusion did not significantly improve hemodynamic response. Bolus-only dosing of methylene blue may be sufficient for the treatment of vasoplegia after cardiac surgery.
比较亚甲蓝给药方案（推注与推注加输注）治疗血管扩张的血流动力学反应。
回顾性队列分析。
克利夫兰诊所的一家单中心学术医疗中心。
克利夫兰诊所接受心脏手术并在 2016 年至 2019 年期间接受亚甲蓝治疗的患者。如果在手术后 >48 小时开始使用亚甲蓝，如果心脏指数 <2.0 L/min/m，或者如果他们因术后出血返回手术室，则将患者排除在分析之外。
亚甲蓝仅推注方案与推注加连续输注亚甲蓝方案。
主要结果是在亚甲蓝给药后 48 小时（1、3、6、12、24 和 48 小时）内血管加压药的需求。评估的其他血流动力学结果包括亚甲蓝反应率、平均动脉压（MAP）和全身血管阻力（SVR）随时间的变化。共纳入 44 例患者进行分析，其中 33 例仅接受亚甲蓝推注。推注组的基础血管加压素需求为 95（95%置信区间：70-122）µg/min 去甲肾上腺素当量（NE），输注组为 100（86-130）µg/min。两组在每个时间点的血管加压素需求均降低，且在整个过程中相似（1 小时平均[95%置信区间]NE，推注 79 [67-91]µg/min v 推注加输注 84 [63-104]µg/min；p=0.71）。MAP、SVR 和亚甲蓝反应率在所有时间点均在两组之间相似。两组的临床结局也相似。
添加亚甲蓝连续输注并未显著改善血流动力学反应。心脏手术后，亚甲蓝仅推注给药可能足以治疗血管扩张。
