Microcirculatory Effects of Methylene Blue

NCT ID: NCT04250389

Last Updated: 2020-01-31

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

25 participants

Study Classification

OBSERVATIONAL

Study Start Date

2017-01-01

Study Completion Date

2019-06-30

Brief Summary

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International guidelines recommend Methylene Blue (MB) as a second-line drug in the treatment of norepinephrine refractory vasoplegic shock (VS) after Cardiopulmonary Bypass CPB. Macrocirculatory effects of MB in this setting are now well established but microcirculatory effects of MB remain unknown.

The purpose of this study is to assess the micro vascular effects of a single administration of methylene blue (1.5 mg/kg over 30 minutes) for norepinephrine-refractory VS post CPB.

Microcirculatory effect will be monitored before and one hour after MB infusion through cutaneous refill time, video microscopy measurements of the sublingual microcirculation and tissue oxygen saturation combined with vascular occlusion test (VOT).

Detailed Description

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Conditions

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Acute Circulatory Failure

Keywords

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Methylene Blue

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Patients with VS receiving methylene blue infusion

The studied population will be all patients receiving methylene blue for refractory vasoplegic shock (VS) after Cardiopulmonary Bypass (CPB). Refractory VS is defined as follow: a dose of norepinephrine \> 0.5µg/kg/min to obtain a mean arterial pressure of 65-75 mmHg with a normal or increase cardiac (\> 2 L.min-1.m-2). Patients will be included in the investigator's 20-bed adult cardiothoracic intensive care unit (ICU) in a tertiary teaching hospital (Hopital Cardiologique Louis Pradel, Hospices Civils de Lyon).

Hemodynamic assessment (micro and macrocirculatory)

Intervention Type OTHER

Each of the variable related to macro- and microcirculatory will be evaluated before and one hour after start of MB infusion.

Macrocirculatory parameters will include :

* Mean, systolic, diastolic arterial, heart rate (HR)
* Cardiac output (CO), sequential vascular response (SVR) and stroke volume (obtained with transthoracic echocardiography or transpulmonary thermodilution catheter if available).
* A passive leg raising (PLR) test will be performed before and one hour after MB infusion. Patients will be classified as fluid responder if they had a CO of at least 10% after PLR.

Microcirculatory parameters will include :

* Cutaneous and gingival refill time
* Tissue oxygen saturation combined with vascular occlusion test (VOT)
* Video microscopy measurements of the sublingual microcirculation
* Metabolic variables: Arterial blood gases including arterial lactate and central venous blood gases.

Interventions

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Hemodynamic assessment (micro and macrocirculatory)

Each of the variable related to macro- and microcirculatory will be evaluated before and one hour after start of MB infusion.

Macrocirculatory parameters will include :

* Mean, systolic, diastolic arterial, heart rate (HR)
* Cardiac output (CO), sequential vascular response (SVR) and stroke volume (obtained with transthoracic echocardiography or transpulmonary thermodilution catheter if available).
* A passive leg raising (PLR) test will be performed before and one hour after MB infusion. Patients will be classified as fluid responder if they had a CO of at least 10% after PLR.

Microcirculatory parameters will include :

* Cutaneous and gingival refill time
* Tissue oxygen saturation combined with vascular occlusion test (VOT)
* Video microscopy measurements of the sublingual microcirculation
* Metabolic variables: Arterial blood gases including arterial lactate and central venous blood gases.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* patients receiving methylene blue prescribed by the clinician in charge of the patient
* patient receiving a dose of norepinephrine \> 0.5µg/kg/min
* normal or increase cardiac (\> 2 L.min-1.m-2) at the time of inclusion
* vasoplegic syndrome post cardiopulmonary bypass for cardiac surgery

Exclusion Criteria

* the need for hemodynamic intervention during the time of study (fluid resuscitation, introduction of inotropic or vasopressor support, change in inotropic support dose)
* age under 18 years
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Hospices Civils de Lyon

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Service d'anesthesie reanimation, Hôpital cardiologique Louis Pradel

Bron, , France

Site Status

Countries

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France

References

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Maurin C, Portran P, Schweizer R, Allaouchiche B, Junot S, Jacquet-Lagreze M, Fellahi JL. Effects of methylene blue on microcirculatory alterations following cardiac surgery: A prospective cohort study. Eur J Anaesthesiol. 2022 Apr 1;39(4):333-341. doi: 10.1097/EJA.0000000000001611.

Reference Type DERIVED
PMID: 34610607 (View on PubMed)

Other Identifiers

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2019_MAGICBLUE

Identifier Type: -

Identifier Source: org_study_id