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7 November 2000 | Volume 133 Issue 9 | Pages 701-706
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 PaO 2 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, PaO 2 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 – PaO 2) 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 – PaO 2 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.
Author and Article Information
From the University of Vienna, Vienna, Austria.
Acknowledgments: The authors thank Gabriele Wölfl of the Department of Medical Statistics at the University of Vienna for help with statistical analysis.
Requests for Single Reprints: Peter Schenk, MD, Department of Internal Medicine 4, Intensive Care, University of Vienna, Allgemeines Krankenhaus, Waehringer Guertel 18-20, A-1090 Vienna, Austria; e-mail, peter.schenk{at}akh-wien.ac.at.
Current Author Addresses: Drs. Schenk and Madl: Department of Internal Medicine 4, Intensive Care, University of Vienna, Allgemeines Krankenhaus, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
Dr. Rezaie-Majd: Department of Internal Medicine 2, Division of Cardiology, University of Vienna, Allgemeines Krankenhaus, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
Mr. Lehr: Department of Medical Statistics, University of Vienna, Schwarzspanierstrasse 17, A-1090 Vienna, Austria.
Dr. Müller: Department of Internal Medicine 4, Division of Gastroenterology, University of Vienna, Allgemeines Krankenhaus, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
Author Contributions: Conception and design: P. Schenk, C. Madl, S. Lehr, C. Müller.
Analysis and interpretation of the data: P. Schenk, C. Madl, S. Rezaie-Majd, S. Lehr, C. Müller.
Drafting of the article: P. Schenk, C. Madl, S. Rezaie-Majd, C. Müller.
Critical revision of the article for important intellectual content: P. Schenk, C. Madl, S. Lehr, C. Müller.
Final approval of the article: P. Schenk, C. Madl, S. Rezaie-Majd, S. Lehr, C. Müller.
Provision of study materials or patients: P. Schenk, C. Madl, S. Rezaie-Majd, C. Müller.
Statistical expertise: P. Schenk, S. Lehr, C. Müller.
Administrative, technical, or logistic support: C. Madl, C. Müller.
Collection and assembly of data: P. Schenk, S. Rezaie-Majd, C. Müller. BRIEF COMMUNICATION
Methylene Blue Improves the Hepatopulmonary Syndrome
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