Home
|
Inbox
|
Search
|
View Abstract
Methylene Blue for Traumatic Vasoplegia
Description
.abstract img { width:300px !important; height:auto; display:block; text-align:center; margin-top:10px } .abstract { overflow-x:scroll } .abstract table { width:100%; display:block; border:hidden; border-collapse: collapse; margin-top:10px } .abstract td, th { border-top: 1px solid #ddd; padding: 4px 8px; } .abstract tbody tr:nth-child(even) td { background-color: #efefef; } .abstract a { overflow-wrap: break-word; word-wrap: break-word; }
A5315 - Methylene Blue for Traumatic Vasoplegia
Author Block: C. Shen, N. Shah, J. Street; Medstar Washington Hospital Center, Washington, DC, United States.
Methylene blue has been described in critical care medicine predominantly for vasoplegia after cardiopulmonary bypass and vasodilatory septic shock. We report the use of methylene blue in trauma induced vasoplegia refractory to fluids, blood products, vasopressors and steroids.
A 17-year old man was transported to our Level 1 trauma center after crashing his motorcycle into a tree. He was in extremis with a positive FAST exam, multiple lower extremity orthopedic fractures, and shock. He was emergently taken to the OR for laparotomy and required a left liver lobectomy, left hepatic and portal vein ligation for bleeding control. Post-operatively, he developed profound hemorrhagic shock, hypothermia and metabolic acidosis. His bleeding remained refractory to massive transfusion protocol, active warming, and sodium bicarbonate infusion. When these measures to achieve hemostasis were refractory, a second ex lap was performed without identification of the source of bleeding. Interventional radiology was required to embolize the gastroduodenal artery. Heroic resuscitation efforts continued (1:1:1 blood product transfusion, prothrombin complex concentrate, tranexamic acid, Factor VII), vasoactive medications (epinephrine, norepinephrine, vasopressin), and hydrocortisone for his multifactorial shock and liver failure. As a salvage intervention, a 100mg bolus of methylene blue was given followed by a 500mg infusion over 6 hours. Within 6 hours of administration, epinephrine and norepinephrine infusions were weaned off and there was a significant reduction in volume requirements.
Methylene blue improves contractility and inhibits the vasodilatory effects of distributive shock through inducible nitric oxide synthase and cGMP-mediated vasodilatation. Methylene blue proved to be an effective rescue therapy with minimal adverse effects in a setting not previously described. We recommend an intravenous bolus of 1mg/kg followed by a continuous infusion of 5mg/kg for 6 hours based on the hemodynamic response. Further research is needed to define the role of methylene blue in trauma induced vasoplegia.
Author Block: C. Shen, N. Shah, J. Street; Medstar Washington Hospital Center, Washington, DC, United States.
Methylene blue has been described in critical care medicine predominantly for vasoplegia after cardiopulmonary bypass and vasodilatory septic shock. We report the use of methylene blue in trauma induced vasoplegia refractory to fluids, blood products, vasopressors and steroids.
A 17-year old man was transported to our Level 1 trauma center after crashing his motorcycle into a tree. He was in extremis with a positive FAST exam, multiple lower extremity orthopedic fractures, and shock. He was emergently taken to the OR for laparotomy and required a left liver lobectomy, left hepatic and portal vein ligation for bleeding control. Post-operatively, he developed profound hemorrhagic shock, hypothermia and metabolic acidosis. His bleeding remained refractory to massive transfusion protocol, active warming, and sodium bicarbonate infusion. When these measures to achieve hemostasis were refractory, a second ex lap was performed without identification of the source of bleeding. Interventional radiology was required to embolize the gastroduodenal artery. Heroic resuscitation efforts continued (1:1:1 blood product transfusion, prothrombin complex concentrate, tranexamic acid, Factor VII), vasoactive medications (epinephrine, norepinephrine, vasopressin), and hydrocortisone for his multifactorial shock and liver failure. As a salvage intervention, a 100mg bolus of methylene blue was given followed by a 500mg infusion over 6 hours. Within 6 hours of administration, epinephrine and norepinephrine infusions were weaned off and there was a significant reduction in volume requirements.
Methylene blue improves contractility and inhibits the vasodilatory effects of distributive shock through inducible nitric oxide synthase and cGMP-mediated vasodilatation. Methylene blue proved to be an effective rescue therapy with minimal adverse effects in a setting not previously described. We recommend an intravenous bolus of 1mg/kg followed by a continuous infusion of 5mg/kg for 6 hours based on the hemodynamic response. Further research is needed to define the role of methylene blue in trauma induced vasoplegia.
|
Home
|
Inbox
|
Search
|