甲烯蓝在重症监护病房血管扩张性休克中的应用：回顾性观察研究。
Methylene blue for vasodilatory shock in the intensive care unit: a retrospective, observational study.
机构信息
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 444, Boston, MA, 02114, USA.
Department of Pharmacy, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
出版信息
BMC Anesthesiol. 2022 Jun 27;22(1):199. doi: 10.1186/s12871-022-01739-w.
BACKGROUND
Refractory vasodilatory shock is a state of uncontrolled vasodilation associated with underlying inflammation and endothelial dysregulation. Rescue therapy for vasoplegia refractory to catecholamines includes methylene blue (MB) which restores vascular tone. We hypothesized that (1) at least 40% of critically ill patients would respond positively to MB administration and (2) that those who responded to MB would have a survival benefit.
METHODS
This study was a retrospective review that included all adult patients admitted to an intensive care unit treated with MB for the indication of refractory vasodilatory shock. Responders to MB were identified as those with a ≥ 10% increase in mean arterial pressure (MAP) within the first 1-2 hours after administration. We examined the association of mortality to the groups of responders versus non-responders to MB. A subgroup analysis in patients undergoing continuous renal replacement therapy (CRRT) was also performed. Statistical calculations were performed in Microsoft Excel® (Redmond, WA, USA). Where appropriate, the comparison of averages and standard deviations of demographics, dosing, MAP, and reductions in vasopressor dosing were performed via Chi squared, Fisher's exact test, or two-tailed t-test with a p-value < 0.05 being considered as statistically significant. After using the F-test to assess for differences in variance, the proper two tailed t-test was used to compare SOFA scores among responders versus non-responders.
RESULTS
A total of 223 patients were included in the responder analysis; 88 (39.5%) had a ≥ 10% increase in MAP post-MB administration that was not associated with a significant change in norepinephrine requirements between responders versus non-responders (p=0.41). There was a non-statistically significant trend (21.6% vs 14.8%, p=0.19) toward improved survival to hospital discharge in the MB responder group compared to the non-responder group. In 70 patients undergoing CRRT, there were 33 responders who were more likely to survive than those who were not (p = 0.0111).
CONCLUSIONS
In patients with refractory shock receiving MB, there is a non-statistically significant trend toward improved outcomes in responders based on a MAP increase >10%. Patients supported with CRRT who were identified as responders had decreased ICU mortality compared to non-responders.
背景
难治性血管扩张性休克是一种不受控制的血管扩张状态，与潜在的炎症和内皮功能失调有关。对儿茶酚胺治疗无效的血管麻痹的抢救治疗包括亚甲蓝（MB），它可以恢复血管张力。我们假设：（1）至少 40%的危重症患者对 MB 治疗有积极反应；（2）对 MB 有反应的患者有生存获益。
方法
这是一项回顾性研究，纳入了所有因难治性血管扩张性休克接受 MB 治疗的重症监护病房成年患者。MB 治疗有反应者定义为在给药后 1-2 小时内平均动脉压（MAP）至少增加 10%。我们检查了死亡率与 MB 治疗有反应组和无反应组之间的关系。还对接受持续肾脏替代治疗（CRRT）的患者进行了亚组分析。统计计算在 Microsoft Excel®（雷德蒙德，华盛顿州，美国）中进行。在适当的情况下，通过卡方检验、Fisher 确切检验或双侧 t 检验比较平均动脉压、血管加压药剂量减少的平均值和标准差，p 值<0.05 被认为具有统计学意义。在用 F 检验评估方差差异后，使用适当的双侧 t 检验比较反应者和无反应者之间的 SOFA 评分。
结果
共有 223 例患者纳入反应者分析；88 例（39.5%）MB 治疗后 MAP 增加≥10%，但与反应者和无反应者之间去甲肾上腺素需求无显著变化相关（p=0.41）。MB 治疗反应者组与无反应者组相比，出院时存活的趋势（21.6% vs 14.8%，p=0.19）有统计学意义。在 70 例接受 CRRT 的患者中，有 33 例反应者的存活几率高于无反应者（p=0.0111）。
结论
在接受 MB 治疗的难治性休克患者中，MAP 增加>10%的反应者的结局有非统计学意义的改善趋势。在 CRRT 支持下被确定为反应者的患者与无反应者相比，ICU 死亡率降低。
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