title: [Methylene blue therapy for vasoplegia after cardiac surgery].
abstract: BACKGROUND
  Systemic inflammatory response syndrome (SIRS) may be associated with critically decreased vascular resistance (vasoplegia syndrome) and become resistant to noradrenaline. Such a condition may be successfully treated with intravenous methylene blue.
  
  
  METHODS
  A 73-year-old patient with acute myocardial infarction and cardiogenic shock was admitted to our centre after failed percutaneous coronary interventions to the left anterior descending coronary artery and underwent emergency coronary revascularisation. After surgery, his ejection fraction was 25%. X-ray revealed pulmonary oedema. The patient became severely hypotensive with marked vasoplegia and metabolic acidosis, despite incremental doses of adrenaline and noradrenaline. 2 mg kg(-1) of methylene blue was administered, which quickly stabilized the patient's general condition.
  
  
  CONCLUSIONS
  Methylene blue applied to vasoplegic patients can effectively increase systemic vascular resistance and restore satisfactory organ perfusion.
authors.affiliation: Oddział Kliniczny Kardioanestezji i Intensywnej Terapii, Slaski Uniwersytet Medyczny, Slaskie Centrum Chorób Serca w Zabrzu. kardanest@sum.edu.pl
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Skuza
authors.forename: Sergiusz
authors.initials: S
authors.lastname: Chmielniak
authors.forename: Wojciech
authors.initials: W
authors.lastname: Dziuk
authors.forename: Ewa
authors.initials: E
authors.lastname: Kucewicz
authors.forename: Szymon
authors.initials: S
authors.lastname: Pawlak
authors.forename: Piotr
authors.initials: P
authors.lastname: Knapik
mesh_terms: D000138:Acidosis / Q000188:drug therapy / Q000209:etiology; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D006801:Humans; D007022:Hypotension / Q000188:drug therapy / Q000209:etiology; D008297:Male; D008751:Methylene Blue / Q000627:therapeutic use*; D009203:Myocardial Infarction / Q000601:surgery; D011654:Pulmonary Edema / Q000188:drug therapy / Q000209:etiology; D012720:Severity of Illness Index; D012770:Shock, Cardiogenic / Q000601:surgery; D014655:Vascular Resistance / Q000187:drug effects; D056987:Vasoplegia / Q000188:drug therapy* / Q000209:etiology
chemical_list: D004791:Enzyme Inhibitors; D008751:Methylene Blue