Methylene blue treatment of pediatric patients in the cardiovascular intensive care unit

Ashley Scheffer
{"title":"Methylene blue treatment of pediatric patients in the cardiovascular intensive care unit","authors":"Ashley Scheffer","doi":"10.13175/swjpcc022-21","DOIUrl":null,"url":null,"abstract":"Background: In both adults and children, hypotension related to a vasoplegic state has multiple etiologies, including septic shock, burn injury or cardiopulmonary bypass-induced vasoplegic syndrome likely due to an increase in nitric oxide (NO) within the vasculature. Methylene blue is used at times to treat this condition, but its use in pediatric cardiac patients has not been described previously in the literature. Objective: 1) Analyze the mean arterial blood pressures and vasoactive-inotropic scores of pediatric patients whose hypotension was treated with methylene blue compared to hypotensive controls; 2) Describe the dose administered and the pathologies of hypotension cited for methylene blue use; 3) Compare the morbidity and mortality of pediatric patients treated with methylene blue versus controls. Design: A retrospective chart review. Setting: Cardiac ICU in a quaternary care free-standing children’s hospital. Patients: Thirty-two patients with congenital heart disease who received methylene blue as treatment for hypotension, fifty patients with congenital heart disease identified as controls. Interventions: None. Measurements and Main Results: Demographic and vital sign data was collected for all pediatric patients treated with methylene blue during a three-year study period. Mixed effects linear regression models analyzed mean arterial blood pressure trends for twelve hours post methylene blue treatment and vasoactive-inotropic scores for twenty-four hours post treatment. Methylene blue use correlated with an increase in mean arterial blood pressure of 10.8mm Hg over a twelve-hour period (p< 0.001). Mean arterial blood pressure trends of patients older than one year did not differ significantly from controls (p=1.00), but patients less than or equal to one year of age had increasing mean arterial blood pressures that were significantly different from controls (p=0.02). Mixed effects linear regression modeling found a statistically significant decrease in vasoactive-inotropic scores over a twenty-four-hour period in the group treated with methylene blue (p< 0.001). This difference remained significant comparted to controls (p=0.003). Survival estimates did not detect a difference between the two groups (p=0.39). Conclusion: Methylene blue may be associated with a decreased need for vasoactive-inotropic support and may correlate with an increase in mean arterial blood pressure in patients who are less than or equal to one year of age.","PeriodicalId":87365,"journal":{"name":"Southwest journal of pulmonary & critical care","volume":" ","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2021-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Southwest journal of pulmonary & critical care","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.13175/swjpcc022-21","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

Abstract

Background: In both adults and children, hypotension related to a vasoplegic state has multiple etiologies, including septic shock, burn injury or cardiopulmonary bypass-induced vasoplegic syndrome likely due to an increase in nitric oxide (NO) within the vasculature. Methylene blue is used at times to treat this condition, but its use in pediatric cardiac patients has not been described previously in the literature. Objective: 1) Analyze the mean arterial blood pressures and vasoactive-inotropic scores of pediatric patients whose hypotension was treated with methylene blue compared to hypotensive controls; 2) Describe the dose administered and the pathologies of hypotension cited for methylene blue use; 3) Compare the morbidity and mortality of pediatric patients treated with methylene blue versus controls. Design: A retrospective chart review. Setting: Cardiac ICU in a quaternary care free-standing children’s hospital. Patients: Thirty-two patients with congenital heart disease who received methylene blue as treatment for hypotension, fifty patients with congenital heart disease identified as controls. Interventions: None. Measurements and Main Results: Demographic and vital sign data was collected for all pediatric patients treated with methylene blue during a three-year study period. Mixed effects linear regression models analyzed mean arterial blood pressure trends for twelve hours post methylene blue treatment and vasoactive-inotropic scores for twenty-four hours post treatment. Methylene blue use correlated with an increase in mean arterial blood pressure of 10.8mm Hg over a twelve-hour period (p< 0.001). Mean arterial blood pressure trends of patients older than one year did not differ significantly from controls (p=1.00), but patients less than or equal to one year of age had increasing mean arterial blood pressures that were significantly different from controls (p=0.02). Mixed effects linear regression modeling found a statistically significant decrease in vasoactive-inotropic scores over a twenty-four-hour period in the group treated with methylene blue (p< 0.001). This difference remained significant comparted to controls (p=0.003). Survival estimates did not detect a difference between the two groups (p=0.39). Conclusion: Methylene blue may be associated with a decreased need for vasoactive-inotropic support and may correlate with an increase in mean arterial blood pressure in patients who are less than or equal to one year of age.
亚甲蓝治疗儿科心血管重症监护室患者
背景:在成人和儿童中,与血管截瘫状态相关的低血压有多种病因,包括感染性休克、烧伤或可能由于血管内一氧化氮(NO)增加而引起的心肺旁路诱导的血管截瘫综合征。亚甲基蓝有时被用来治疗这种情况,但它在儿科心脏病患者中的使用在以前的文献中没有描述。目的:1)分析亚甲基蓝治疗低血压患儿与对照组的平均动脉血压和血管活性-肌力评分;2)描述使用亚甲基蓝的剂量和低血压病理;3)比较亚甲基蓝治疗的儿科患者与对照组的发病率和死亡率。设计:回顾性图表回顾。环境:某独立儿童医院心脏重症监护室。患者:32例先天性心脏病患者接受亚甲基蓝治疗低血压,50例先天性心脏病患者作为对照。干预措施:没有。测量和主要结果:在为期三年的研究期间,收集了所有接受亚甲蓝治疗的儿科患者的人口统计学和生命体征数据。混合效应线性回归模型分析了亚甲基蓝治疗后12小时的平均动脉血压趋势和治疗后24小时的血管活性-肌力得分。亚甲基蓝的使用与12小时内平均动脉血压升高10.8mm Hg相关(p< 0.001)。年龄大于1岁的患者平均动脉血压趋势与对照组无显著差异(p=1.00),但小于或等于1岁的患者平均动脉血压升高,与对照组有显著差异(p=0.02)。混合效应线性回归模型发现,亚甲基蓝治疗组血管活性-肌力性评分在24小时内显著下降(p< 0.001)。与对照组相比,这一差异仍然显著(p=0.003)。两组的生存估计没有发现差异(p=0.39)。结论:亚甲基蓝可能与降低对血管活性-肌力支持的需求有关,并且可能与小于或等于1岁的患者平均动脉血压升高有关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
自引率
0.00%
发文量
0
审稿时长
1 weeks
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信