000097114 001__ 97114
000097114 005__ 20210902121908.0
000097114 0247_ $$2doi$$a10.22514/sv.2020.16.0063
000097114 0248_ $$2sideral$$a121256
000097114 037__ $$aART-2020-121256
000097114 041__ $$aeng
000097114 100__ $$aAragón-Benedí, C.
000097114 245__ $$aMethylene blue? Therapeutic alternative in the management of septic shock refractory to norepinephrine
000097114 260__ $$c2020
000097114 5060_ $$aAccess copy available to the general public$$fUnrestricted
000097114 5203_ $$aIntroduction: Methylene blue is receiving special interest in perioperative and intensive care of patients with distributive shock due to its ability to block the action of nitric oxide and to antagonize deep vasodilation.
Objective: The objective is to illustrate the use of the methylene blue, summarizing the perioperative management of a case with secondary vasoplegic syndrome due to a norepinephrine refractory septic shock and the response to methylene blue, reviewing the latest evidence of this therapeutic alternative. In practice:We describe the case of a 60-year-old man, paraplegic, with septic shock due to a long evolution decubitus pressure ulcer. After two hours of surgery, the patient remained with hemodynamic deterioration despite high doses of vasopressin (3 IU/hour) and norepinephrine (2 µg/kg /min), therefore methylene blue was administered with two intravenous bolus doses of 50 mg without adverse effects. After half an hour hemodynamic improvement was evidenced, allowing to decrease norepinephrine infusion and normalizing blood pressure. Finally, debridement of necrotic tissue, amputation and disarticulation of left coxofemoral joint was performed with subsequent transfer to the ICU and discharge to the spinal cord injury ward twenty eight days later.
Conclusions: As it has been demonstrated in our patient, methylene blue is a therapeutic alternative to manage patients with persistent hypotension despite the use of various vasopressors during the management of vasoplegic syndrome secondary to septic shock.
000097114 536__ $$9info:eu-repo/grantAgreement/ES/DGA-FEDER/B26-17D
000097114 540__ $$9info:eu-repo/semantics/openAccess$$aby$$uhttp://creativecommons.org/licenses/by/3.0/es/
000097114 590__ $$a0.63$$b2020
000097114 591__ $$aEMERGENCY MEDICINE$$b30 / 32 = 0.938$$c2020$$dQ4$$eT3
000097114 592__ $$a0.14$$b2020
000097114 593__ $$aEmergency Medicine$$c2020$$dQ4
000097114 593__ $$aCritical Care and Intensive Care Medicine$$c2020$$dQ4
000097114 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/publishedVersion
000097114 700__ $$0(orcid)0000-0001-9440-8282$$aPascual-Bellosta, A.$$uUniversidad de Zaragoza
000097114 700__ $$0(orcid)0000-0002-2378-8668$$aOrtega-Lucea, S.$$uUniversidad de Zaragoza
000097114 700__ $$aLacosta-Torrijos, L.
000097114 700__ $$0(orcid)0000-0002-6314-551X$$aJiménez-Bernadó, T.$$uUniversidad de Zaragoza
000097114 700__ $$0(orcid)0000-0003-2462-1904$$aMartínez-Ubieto, J.$$uUniversidad de Zaragoza
000097114 7102_ $$11006$$2255$$aUniversidad de Zaragoza$$bDpto. Fisiatría y Enfermería$$cÁrea Enfermería
000097114 7102_ $$11013$$2090$$aUniversidad de Zaragoza$$bDpto. Cirugía$$cÁrea Cirugía
000097114 773__ $$g16, 2 (2020), 199-202$$pSigna Vitae$$tSigna Vitae$$x1334-5605
000097114 8564_ $$s309259$$uhttps://zaguan.unizar.es/record/97114/files/texto_completo.pdf$$yVersión publicada
000097114 8564_ $$s619181$$uhttps://zaguan.unizar.es/record/97114/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada
000097114 909CO $$ooai:zaguan.unizar.es:97114$$particulos$$pdriver
000097114 951__ $$a2021-09-02-10:40:55
000097114 980__ $$aARTICLE