Journal of Critical Care
Volume 25, Issue 2 , Pages 358.e1-358.e7 , June 2010

The effects of methylene blue infusion on gastric tonometry and intestinal fatty acid binding protein levels in septic shock patients

  • Frank M.P. van Haren

      Affiliations

    • Intensive Care Department, Waikato Hospital, Hamilton 3240, New Zealand
    • Corresponding Author InformationCorresponding author. Intensive Care Department, Waikato Hospital, Hamilton, New Zealand. Tel.: +64 7 8398899; fax: +64 7 839 8912.
    • ,
  • Peter Pickkers

      Affiliations

    • Intensive Care Department, Radboud University Nijmegen Medical Centre, Nijmegen 6500 HB, The Netherlands
    • ,
  • Norbert Foudraine

      Affiliations

    • Intensive Care Department, VieCuri Medical Centre, Venlo 5912 BL, The Netherlands
    • ,
  • Suzanne Heemskerk

      Affiliations

    • Intensive Care Department, Radboud University Nijmegen Medical Centre, Nijmegen 6500 HB, The Netherlands
    • Department of Pharmacology and Toxicology, Radboud University Nijmegen Medical Centre, Nijmegen 6500 HB, The Netherlands
    • ,
  • James Sleigh

      Affiliations

    • Intensive Care Department, Waikato Hospital, Hamilton 3240, New Zealand
    • ,
  • Johannes G. van der Hoeven

      Affiliations

    • Intensive Care Department, Radboud University Nijmegen Medical Centre, Nijmegen 6500 HB, The Netherlands

References 

  1. Angus DC, Linde-Zwirble WT, Lidicker J, et al. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29:1303–1310
  2. Alberti C, Brun-Buisson C, Goodman SV, et al. Influence of systemic inflammatory response syndrome and sepsis on outcome of critically ill infected patients. Am J Respir Crit Care Med. 2003;168:77–84
  3. Vincent JL, Zhang H, Szabo C, et al. Effects of nitric oxide in septic shock. Am J Respir Crit Care Med. 2000;161:1781–1785
  4. Lopez A, Lorente JA, Steingrub J, et al. Multiple-center, randomized, placebo-controlled, double-blind study of the nitric oxide synthase inhibitor 546C88: effect on survival in patients with septic shock. Crit Care Med. 2004;32:21–30
  5. Mayer B, Brunner F, Schmidt K. Inhibition of nitric oxide synthesis by methylene blue. Biochem Pharmacol. 1993;45:367–374
  6. Marczin N, Ryan US, Catravas JD. Methylene blue inhibits nitrovasodilator- and endothelium-derived relaxing factor-induced cyclic GMP accumulation in cultured pulmonary arterial smooth muscle cells via generation of superoxide anion. J Pharmacol Exp Ther. 1992;263:170–179
  7. Kirov MY, Evgenov OV, Evgenov NV, et al. Infusion of methylene blue in human septic shock: a pilot, randomized, controlled study. Crit Care Med. 2001;29:1860–1867
  8. Kwok ES, Howes D. Use of methylene blue in sepsis: a systematic review. J Intensive Care Med. 2006;21:359–363
  9. Memis D, Karamanlioglu B, Yuksel M, et al. The influence of methylene blue infusion on cytokine levels during severe sepsis. Anaesth Intensive Care. 2002;30:755–762
  10. Mokhlesi B, Leikin JB, Murray P, et al. Adult toxicology in critical care: Part II: specific poisonings. Chest. 2003;123:897–922
  11. van Haren FM, Sleigh JW, Pickkers P, et al. Gastrointestinal perfusion in septic shock. Anaesth Intensive Care. 2007;35:679–694
  12. Matheson PJ, Wilson MA, Garrison RN. Regulation of intestinal blood flow. J Surg Res. 2000;93:182–196
  13. Levy B, Gawalkiewicz P, Vallet B, et al. Gastric capnometry with air-automated tonometry predicts outcome in critically ill patients. Crit Care Med. 2003;31:474–480
  14. Chmurzynska A. The multigene family of fatty acid-binding proteins (FABPs): function, structure and polymorphism. J Appl Genet. 2006;47:39–48
  15. Pelsers MM, Hermens WT, Glatz JF. Fatty acid-binding proteins as plasma markers of tissue injury. Clin Chim Acta. 2005;352:15–35
  16. Niewold TA, Meinen M, van der Meulen J. Plasma intestinal fatty acid binding protein (I-FABP) concentrations increase following intestinal ischemia in pigs. Res Vet Sci. 2004;77:89–91
  17. Lieberman JM, Marks WH, Cohn S, et al. Organ failure, infection, and the systemic inflammatory response syndrome are associated with elevated levels of urinary intestinal fatty acid binding protein: study of 100 consecutive patients in a surgical intensive care unit. J Trauma. 1998;45:900–906
  18. Gollin G, Zieg PM, Cohn SM, et al. Intestinal mucosal injury in critically ill surgical patients: preliminary observations. Am Surg. 1999;65:19–21
  19. Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Intensive Care Med. 2003;29:530–538
  20. Kirsch IR, Cohen HJ. Heinz body hemolytic anemia from the use of methylene blue in neonates. J Pediatr. 1980;96:276–278
  21. Curry S. Methemoglobinemia. Ann Emerg Med. 1982;11:214–221
  22. Huybregts RA, Morariu AM, Rakhorst G, et al. Attenuated renal and intestinal injury after use of a mini-cardiopulmonary bypass system. Ann Thorac Surg. 2007;83:1760–1766
  23. van Haren FM, Rozendaal FW, van der Hoeven JG. The effect of vasopressin on gastric perfusion in catecholamine-dependent patients in septic shock. Chest. 2003;124:2256–2260
  24. Heemskerk S, van Haren FM, Foudraine NA, et al. Short-term beneficial effects of methylene blue on kidney damage in septic shock patients. Intensive Care Med. 2008;34:350–354
  25. Perner A, Faber T. Stroke volume variation does not predict fluid responsiveness in patients with septic shock on pressure support ventilation. Acta Anaesthesiol Scand. 2006;50:1068–1073
  26. Michard F, Teboul JL. Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence. Chest. 2002;121:2000–2008
  27. Stawicki SP, Sims C, Sarani B, et al. Methylene blue and vasoplegia: who, when, and how?. Mini Rev Med Chem. 2008;8:472–490
  28. LeDoux D, Astiz ME, Carpati CM, et al. Effects of perfusion pressure on tissue perfusion in septic shock. Crit Care Med. 2000;28:2729–2732
  29. Asfar P, De Backer D, Meier-Hellmann A, et al. Clinical review: influence of vasoactive and other therapies on intestinal and hepatic circulations in patients with septic shock. Crit Care. 2004;8:170–179
  30. Meile T, Glatzle J, Habermann FM, et al. Nitric oxide synthase inhibition results in immediate postoperative recovery of gastric, small intestinal and colonic motility in awake rats. Int J Colorectal Dis. 2006;21:121–129
  31. Demirbilek S, Sizanli E, Karadag N, et al. The effects of methylene blue on lung injury in septic rats. Eur Surg Res. 2006;38:35–41
  32. Donati A, Conti G, Loggi S, et al. Does methylene blue administration to septic shock patients affect vascular permeability and blood volume?. Crit Care Med. 2002;30:2271–2277
  33. Sweet G, Standiford SB. Methylene-blue-associated encephalopathy. J Am Coll Surg. 2007;204:454–458
  34. Kessler MR, Eide T, Humayun B, et al. Spurious pulse oximeter desaturation with methylene blue injection. Anesthesiology. 1986;65:435–436
  35. Iskit AB, Guc O. Effects of endothelin and nitric oxide on organ injury, mesenteric ischemia, and survival in experimental models of septic shock. Acta Pharmacol Sin. 2003;24:953–957

☆ The authors disclose no conflict of interest.

☆☆ The study was performed at the Intensive Care Department, VieCuri Medical Centre, Venlo, The Netherlands.

★ Trial registration at Australian New Zealand Clinical Trials Registry (www.anzctr.org.au). Registration number ACTRN12608000090314

PII: S0883-9441(10)00063-8

doi: 10.1016/j.jcrc.2010.02.008

Journal of Critical Care
Volume 25, Issue 2 , Pages 358.e1-358.e7 , June 2010

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