0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Brief Communications |

Methylene Blue Improves the Hepatopulmonary Syndrome

Peter Schenk, MD; Christian Madl, MD; Shahrzad Rezaie-Majd, MD; Stephan Lehr; and Christian Müller, MD
[+] Article and Author Information

Copyright ©2004 by the American College of Physicians


Ann Intern Med. 2000;133(9):701-706. doi:10.7326/0003-4819-133-9-200011070-00012
Text Size: A A A

Background: The hypoxemia of the hepatopulmonary syndrome, seen in patients with severe chronic liver dysfunction, results from widespread pulmonary vasodilation. No established drug therapy is available for this condition.

Objective: To study the effect of methylene blue, a potent inhibitor of guanylate cyclase, in patients with severe hepatopulmonary syndrome.

Design: Open, uncontrolled trial.

Setting: Medical intensive care unit at the university hospital in Vienna, Austria.

Patients: 7 patients with advanced cirrhosis and severe hepatopulmonary syndrome with PaO2 of 60 mm Hg or less.

Intervention: Insertion of a pulmonary artery catheter and an arterial indwelling catheter; intravenous administration of methylene blue, 3 mg/kg of body weight, over a 15-minute period.

Measurements: Serial measurements of gas exchange and hemodynamic variables.

Results: After methylene blue administration, PaO2 increased in all patients (from a baseline mean ± SD of 58 ± 2.5 mm Hg to 74 ± 11.5 mm Hg 5 hours after infusion; P = 0.006) and the alveolar–arterial difference for partial pressure of oxygen (PAO2 − PaO2) decreased in all patients, with a maximum effect achieved after 5 hours (from 49 ± 3.3 mm Hg to 30 ± 10.4 mm Hg; P = 0.003); even after 10 hours, PAO2 − PaO2 was still significantly reduced compared with baseline (P = 0.041). Oxygenation improved because of reduction in shunt fraction (from 41% ± 3.1% to 25% ± 4.5%; P < 0.001). Mean pulmonary artery pressure increased (from 20 ± 5.2 mm Hg to 23 ± 3.6 mm Hg; P = 0.028), as did pulmonary vascular resistance (from 58 ± 23 dyne/sec · cm −5 to 115 ± 56 dyne/sec · cm −5; P = 0.012). Arterial blood pressure did not change significantly. Cardiac output decreased (from 10.6 ± 2.2 L/min to 8.6 ± 2.7 L/min; P = 0.008) and systemic vascular resistance increased (from 527 ± 144 dyne/sec · cm −5 to 729 ± 222 dyne/sec · cm −5; P = 0.037). Heart rate, central venous pressure, and pulmonary capillary wedge pressure remained unchanged.

Conclusion: Intravenous methylene blue improved hypoxemia and hyperdynamic circulation in patients with liver cirrhosis and severe hepatopulmonary syndrome.

Figures

Grahic Jump Location
Figure.
Effect of methylene blue infusion in each patient.

Shown are baseline values (timepoint 0) and serial measurements after methylene blue infusion, 3 mg/kg of body weight injected over a period of 15 minutes, of Pa , alveolar–arterial difference for the partial pressure of oxygen, and pulmonary shunt fraction. Black circles represent patient 1, black squares represent patient 2, black triangles represent patient 3, black diamonds represent patient 4, asterisks represent patient 5, white circles represent patient 6, and white squares represent patient 7.

Grahic Jump Location

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Methylene Blue To Treat Hepatopulmonary Syndrome

Copyright ©2004 by the American College of Physicians

Read More...

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Topic Collections
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)