Clinical utility of midodrine and methylene blue as catecholamine-sparing agents in intensive care unit patients with shock

Tchen, Stephanie; Sullivan, Jesse

doi:10.1016/j.jcrc.2020.02.011

Cited by 30 publications

(36 citation statements)

References 68 publications

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“…This is supported by its concentration levels in blood that have been found to be four to five times higher than in plasma [11]. Among their clinical and experimental applications [4,[12][13][14][15], the most common directions of research related with the use of MB and PRO in biomedical and clinical fields are schematically presented in Figure 1. The recommended doses for the clinical applications of MB are already well known and are between 1-2 mg/kg/day, while signs of toxicity, like the formation of Heinz bodies in human erythrocytes, appear at much higher concentrations, namely 7.5 mg/kg/day.…”

Section: Introductionmentioning

confidence: 93%

“…Due to the fact that MB acts as a cationic dye that forms electrostatic bonds with negatively-charged moieties, it is intensively used as redox probe and intercalator in designing DNA and aptamer-based sensors [1][2][3]. This reversible staining minimizes interference when nucleic acids are transferred to hybridization membranes for blotting [4].…”

Section: Introductionmentioning

confidence: 99%

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Comparative Study Regarding the Properties of Methylene Blue and Proflavine and Their Optimal Concentrations for In Vitro and In Vivo Applications

et al. 2020

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Methylene blue and proflavine are fluorescent dyes used to stain nucleic acid from the molecular level to the tissue level. Already clinically used for sentinel node mapping, detection of neuroendocrine tumors, methemoglobinemia, septic shock, ifosfamide-induced encephalopathy, and photodynamic inactivation of RNA viruses, the antimicrobial, anti-inflammatory, and antioxidant effect of methylene blue has been demonstrated in different in vitro and in vivo studies. Proflavine was used as a disinfectant and bacteriostatic agent against many gram-positive bacteria, as well as a urinary antiseptic involved in highlighting cell nuclei. At the tissue level, the anti-inflammatory effects of methylene blue protect against pulmonary, renal, cardiac, pancreatic, ischemic-reperfusion lesions, and fevers. First used for their antiseptic and antiviral activity, respectively, methylene blue and proflavine turned out to be excellent dyes for diagnostic and treatment purposes. In vitro and in vivo studies demonstrated that both dyes are efficient as perfusion and tissue tracers and permitted to evaluate the minimal efficient concentration in different species, as well as their pharmacokinetics and toxicity. This review aims to identify the optimal concentrations of methylene blue and proflavine that can be used for in vivo experiments to highlight the vascularization of the skin in the case of a perforasome (both as a tissue tracer and in vascular mapping), as well as their effects on tissues. This review is intended to be a comparative and critical presentation of the possible applications of methylene blue (MB) and proflavine (PRO) in the surgical field, and the relevant biomedical findings from specialized literature to date are discussed as well.

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Section: Introductionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Comparative Study Regarding the Properties of Methylene Blue and Proflavine and Their Optimal Concentrations for In Vitro and In Vivo Applications

et al. 2020

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“…1) [20]. MB also has the ability to scavenge NO as well as to selectively inhibit iNOs [21]. When given intravenously, MB concentrations peak at 30 min with an onset of action of 30-60 min.…”

Section: Methylene Bluementioning

confidence: 99%

“…It has a relatively large volume of distribution (255 ± 58 L) and is highly protein bound (94%). Excretion occurs via the bile, fecal, and renal routes [20][21][22]. Intravenous administration typically has a terminal plasma half-life of 5-6 h, and continuous infusions may be beneficial after the initial bolus for up to 48-72 h. As a result of the short-term effects of MB, a number of studies also evaluated prolonged infusions of MB with doses of 0.25-2 mg/kg/h, up to 120 h [20][21][22].…”

Section: Methylene Bluementioning

confidence: 99%

“…A less common but well-established use of MB is the treatment of methemoglobinemia complicating topical benzocaine use, where MB hastens the conversion of methemoglobin to hemoglobin. MB has also been utilized in patients with congenital methemoglobinemia, priapism, neonatal hypotension, or as an antimalarial agent [20,21]. In vasodilatory shock, a therapeutic bolus of 1-2 mg/kg is commonly administered over 10-20 min, or up to 1 h. The appealing mechanism of action of MB (i.e., selectively blocking sGC as well as inhibiting iNOS) explains why it is regarded not as a pure vasoconstrictor but instead as a selective agent on the microcirculation dysregulation in cases of NO upregulation.…”

Section: Methylene Bluementioning

confidence: 99%

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Vasopressor-Sparing Action of Methylene Blue in Severe Sepsis and Shock: A Narrative Review

Puntillo

Giglio²,

Pasqualucci

et al. 2020

Adv Ther

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Shock is a serious acute circulatory failure leading to inadequate oxygen delivery to the cells. Its treatment is mainly based on circulating fluid optimization, and vasopressors to provide an adequate mean arterial pressure and microcirculatory flow. Norepinephrine is the drug of choice, but high dosages may be responsible for several side effects, including increased myocardial oxygen consumption, dysrhythmias, and peripheral and organ ischemia. Moreover, some patients are ''non-responders'' to first-line norepinephrine treatment. Hence, other drugs have been proposed to reach and maintain the hemodynamic target. In general, they are described as catecholaminesparing agents. Among others, the most used are vasopressin, corticosteroids, and angiotensin II. Methylene blue (MB) represents a further option, even though its use is still a topic of controversy. This review article tries to summarize what is known and unknown about the actions of MB in patients in shock. It reduces excessive production of nitric oxide via blockade of guanylate cyclase in shock states. At present, it appears the MB provides positive results in septic shock, if administered early. Further randomized controlled trials are warranted regarding its use to provide more precise indications to physicians involved in the treatment of such patients.

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Effect of midodrine versus placebo on time to vasopressor discontinuation in patients with persistent hypotension in the intensive care unit (MIDAS): an international randomised clinical trial

et al. 2020

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Consent to participate: Written informed consent was obtained from all subjects or their legally authorised representatives. Consent for publication: Not applicableAvailability of data and material: De-identified data collected during the trial will be made available upon reasonable request to researchers who provide a methodologically sound proposal, after approval by the study authors, and with a signed data access agreement. Questions about data are handled by the corresponding author.

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Clinical utility of midodrine and methylene blue as catecholamine-sparing agents in intensive care unit patients with shock

Cited by 30 publications

References 68 publications

Comparative Study Regarding the Properties of Methylene Blue and Proflavine and Their Optimal Concentrations for In Vitro and In Vivo Applications

Comparative Study Regarding the Properties of Methylene Blue and Proflavine and Their Optimal Concentrations for In Vitro and In Vivo Applications

Vasopressor-Sparing Action of Methylene Blue in Severe Sepsis and Shock: A Narrative Review

Effect of midodrine versus placebo on time to vasopressor discontinuation in patients with persistent hypotension in the intensive care unit (MIDAS): an international randomised clinical trial

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