[Inhibition of the nitric oxide pathway in refractory septic shock].
OBJECTIVE
To assess the acute effects of methylene blue infusion, an inhibitor of nitric oxide synthesis, on hemodynamic parameters in patients with refractory septic shock.


METHODS
Fourteen patients admitted to intensive care units with septic shock of diverse etiologies and unable to maintain median arterial pressures over 60 mm Hg with the use of at least 2 vasoactive drugs, were studied. All received a 1 mg/kg bolus of methylene blue Hemodynamic parameters were measured before and 30, 60, 120 and 180 min after the bolus.


RESULTS
Systolic and diastolic blood pressure and systemic vascular resistance increased in all patients. There were no significant changes in cardiac output, oxygen consumption or extraction.


CONCLUSIONS
Methylene blue has an acute pressor effect in patients with septic shock.
Andresen
M
M
Unidade de Terapia Intensiva Médica, Hospital Clínico, Universidad Católica, Santiago de Chile.
Dougnac
A
A
Hernández
G
G
Espejo
J
J
Castillo
L
L
Bugedo
G
G
Letelier
L M
LM
Dagnino
J
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004298:Dopamine / Q000494:pharmacology; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008751:Methylene Blue / Q000494:pharmacology; D008875:Middle Aged; D009569:Nitric Oxide / Q000037:antagonists & inhibitors* / Q000378:metabolism; D009638:Norepinephrine / Q000494:pharmacology; D011446:Prospective Studies; D012772:Shock, Septic / Q000378:metabolism*
D009569:Nitric Oxide; D008751:Methylene Blue; D004298:Dopamine; D009638:Norepinephrine