The mystery of methylene blue and its role in managing post-cardiac surgery vasoplegic shock
Background Vasoplegic syndrome is associated with high mortality. Methylene blue (MB) is a guanylate cyclase inhibitor that ameliorates this re-distributive type of shock. This study aims to investigate the outcome in patients who received MB early postoperatively.Methods 2753 patients who underwent...
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Taylor & Francis Group
2025-12-01
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| Series: | Annals of Medicine |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/07853890.2025.2460770 |
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| author | Mohamed Elbayomi Oliver Dewald Presheet Pathare Markus Kondruweit Rene Tandler Michael Weyand Christian Heim |
| author_facet | Mohamed Elbayomi Oliver Dewald Presheet Pathare Markus Kondruweit Rene Tandler Michael Weyand Christian Heim |
| author_sort | Mohamed Elbayomi |
| collection | DOAJ |
| description | Background Vasoplegic syndrome is associated with high mortality. Methylene blue (MB) is a guanylate cyclase inhibitor that ameliorates this re-distributive type of shock. This study aims to investigate the outcome in patients who received MB early postoperatively.Methods 2753 patients who underwent cardiac surgery utilizing cardiopulmonary bypass at our institution in a time interval of two years were identified. The incidence of vasoplegic syndrome was 7.2% (n = 200). Pharmacy records identified 84 patients (group 1, MB group) who received methylene blue and 116 patients (group 2, Control group) who didn’t receive the drug. This single-center retrospective cohort study’s primary outcome was in-hospital mortality. Secondary outcomes were postoperative hemodialysis, serum lactate levels at 24 h postoperatively, and intensive care unit stay length in days.Results MB patients have a shorter ICU stay as compared to the control group (9 ± 8 days vs. 16 ± 6.9; p-value <.001). In the control group, postoperative hemodialysis was higher (20% in the MB group and 40% in the control group; p-value <.05). At 24 h post-op, the methylene blue group had reduced serum lactate levels (1.8 ± 1.2 vs. 4 ± 1.8 in the control group; p-value <.001). The methylene blue group had a decreased 24-hour norepinephrine dose (1.5 ± 1.2 vs. 2.8 ± 2 in the control group; p-value <.05). In-hospital mortality was not significantly different between the two groups (38% in the MB group vs. 43% in the control group).Conclusion Early postoperative administration of methylene blue in patients with vasoplegic syndrome shortens intensive care unit stay and contributes to less end-organ damage. |
| format | Article |
| id | doaj-art-158a0480c3d643b386302c8951768ed0 |
| institution | Kabale University |
| issn | 0785-3890 1365-2060 |
| language | English |
| publishDate | 2025-12-01 |
| publisher | Taylor & Francis Group |
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| series | Annals of Medicine |
| spelling | doaj-art-158a0480c3d643b386302c8951768ed02025-02-04T16:42:31ZengTaylor & Francis GroupAnnals of Medicine0785-38901365-20602025-12-0157110.1080/07853890.2025.2460770The mystery of methylene blue and its role in managing post-cardiac surgery vasoplegic shockMohamed Elbayomi0Oliver Dewald1Presheet Pathare2Markus Kondruweit3Rene Tandler4Michael Weyand5Christian Heim6Department of Cardiac Surgery, Friedrich-Alexander-University, Erlangen, Bavaria, GermanyDepartment of Cardiac Surgery, Friedrich-Alexander-University, Erlangen, Bavaria, GermanyDepartment of Cardiac Surgery, Friedrich-Alexander-University, Erlangen, Bavaria, GermanyDepartment of Cardiac Surgery, Friedrich-Alexander-University, Erlangen, Bavaria, GermanyCardiac and Vascular Surgery, Klinikum Bayreuth, Medical Campus Oberfranken of Friedrich Alexander University, Bayreuth, GermanyDepartment of Cardiac Surgery, Friedrich-Alexander-University, Erlangen, Bavaria, GermanyCardiac and Vascular Surgery, Klinikum Bayreuth, Medical Campus Oberfranken of Friedrich Alexander University, Bayreuth, GermanyBackground Vasoplegic syndrome is associated with high mortality. Methylene blue (MB) is a guanylate cyclase inhibitor that ameliorates this re-distributive type of shock. This study aims to investigate the outcome in patients who received MB early postoperatively.Methods 2753 patients who underwent cardiac surgery utilizing cardiopulmonary bypass at our institution in a time interval of two years were identified. The incidence of vasoplegic syndrome was 7.2% (n = 200). Pharmacy records identified 84 patients (group 1, MB group) who received methylene blue and 116 patients (group 2, Control group) who didn’t receive the drug. This single-center retrospective cohort study’s primary outcome was in-hospital mortality. Secondary outcomes were postoperative hemodialysis, serum lactate levels at 24 h postoperatively, and intensive care unit stay length in days.Results MB patients have a shorter ICU stay as compared to the control group (9 ± 8 days vs. 16 ± 6.9; p-value <.001). In the control group, postoperative hemodialysis was higher (20% in the MB group and 40% in the control group; p-value <.05). At 24 h post-op, the methylene blue group had reduced serum lactate levels (1.8 ± 1.2 vs. 4 ± 1.8 in the control group; p-value <.001). The methylene blue group had a decreased 24-hour norepinephrine dose (1.5 ± 1.2 vs. 2.8 ± 2 in the control group; p-value <.05). In-hospital mortality was not significantly different between the two groups (38% in the MB group vs. 43% in the control group).Conclusion Early postoperative administration of methylene blue in patients with vasoplegic syndrome shortens intensive care unit stay and contributes to less end-organ damage.https://www.tandfonline.com/doi/10.1080/07853890.2025.2460770Cardiopulmonary bypassvasoplegic syndromemethylene blue |
| spellingShingle | Mohamed Elbayomi Oliver Dewald Presheet Pathare Markus Kondruweit Rene Tandler Michael Weyand Christian Heim The mystery of methylene blue and its role in managing post-cardiac surgery vasoplegic shock Annals of Medicine Cardiopulmonary bypass vasoplegic syndrome methylene blue |
| title | The mystery of methylene blue and its role in managing post-cardiac surgery vasoplegic shock |
| title_full | The mystery of methylene blue and its role in managing post-cardiac surgery vasoplegic shock |
| title_fullStr | The mystery of methylene blue and its role in managing post-cardiac surgery vasoplegic shock |
| title_full_unstemmed | The mystery of methylene blue and its role in managing post-cardiac surgery vasoplegic shock |
| title_short | The mystery of methylene blue and its role in managing post-cardiac surgery vasoplegic shock |
| title_sort | mystery of methylene blue and its role in managing post cardiac surgery vasoplegic shock |
| topic | Cardiopulmonary bypass vasoplegic syndrome methylene blue |
| url | https://www.tandfonline.com/doi/10.1080/07853890.2025.2460770 |
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