Is the cyclic GMP system underestimated by intensive care and emergency teams?

被引：12

作者：

Barbosa Evora, Paulo Roberto ^{[1
]}

Rodrigues, Alfredo Jose ^{[1
]}

de Andrade Vicente, Walter Vilella ^{[1
]}

de Andrade Vicente, Yvone Avalloni ^{[1
]}

Basseto, Solange ^{[1
]}

Basile Filho, Anibal ^{[1
]}

Capellini, Verena K. ^{[1
]}

机构：

[1] Univ Sao Paulo, Ribeirao Preto Fac Med, Dept Surg & Anat, Sao Paulo, Brazil

来源：

MEDICAL HYPOTHESES | 2007年 / 69卷 / 03期

基金：

巴西圣保罗研究基金会;

关键词：

D O I：

10.1016/j.mehy.2007.01.041

中图分类号：

R-3 [医学研究方法]; R3 [基础医学];

学科分类号：

1001 ;

摘要：

At present, the clinical management inflammatory vasoplegia associated to sepsis or anaphylaxis is symptomatic. Volume is expanded by means of administration of fluids, and low blood pressure is managed by means of administration of positive inotropes and vasoconstrictors. This therapeutic approach is mainly associated to the cyclic AMP (cAMP) and, many times the circulatory shock is refractory to high amines concentrations. However, beside of cAMP-dependent vasoreactivity mechanisms there are other two known vasoplegia involved mechanisms: cyclic GMP (cGMP) and hyperpolarization that is less clinically considered. Also, it is possible to speculate about 'probable vasopressin deficiency'. Methylene blue (MB) is the most useful and clinically safe cGMP blocker. We propose a decision tree for diagnosis and institution of this therapeutical approach many times underestimate by intensive care and emergency teams. (c) 2007 Elsevier Ltd. All rights reserved.

引用

页码：564 / 567

页数：4

共 15 条

[1] The use of methylene blue in the treatment of anaphylactic shock induced by compound 48/80: Experimental studies in rabbits [J].

Buzato, MAS ;

Viaro, F ;

Piccinato, CE ;

Evora, PRB .

SHOCK, 2005, 23 (06) :582-587

[2] Effect of methylene blue on refractory neonatal hypotension [J].

Driscoll, W ;

Thurin, S ;

Carrion, V ;

Steinhorn, RH ;

Morin, FC .

JOURNAL OF PEDIATRICS, 1996, 129 (06) :904-908

[3] The Guanylyl cyclase inhibition by MB as vasoplegic circulatory shock therapeutical target [J].

Evora, P. R. B. ;

Viaro, F. .

CURRENT DRUG TARGETS, 2006, 7 (09) :1195-1204

[4] Should methylene blue be the drug of choice to treat vasoplegias caused by cardiopulmonary bypass and anaphylactic shock? [J].

Evora, PRB .

JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2000, 119 (03) :632-633

[5] An open discussion about endothelial dysfunction: is it timely to propose a classification? [J].

Evora, PRB .

INTERNATIONAL JOURNAL OF CARDIOLOGY, 2000, 73 (03) :289-292

[6]

Evora PRB, 1997, ANN THORAC SURG, V63, P1212

[7]

Joviliano Edwaldo E, 2005, Vasc Endovascular Surg, V39, P39, DOI 10.1177/153857440503900114

[8]

Kilbourn R G, 1997, Dis Mon, V43, P277

[9] Infusion of methylene blue in human septic shock: A pilot, randomized, controlled study [J].

Kirov, MY ;

Evgenov, OV ;

Evgenov, NV ;

Egorina, EM ;

Sovershaev, MA ;

Sveinbjornsson, B ;

Nedashkovsky, EV ;

Bjertnaes, LJ .

CRITICAL CARE MEDICINE, 2001, 29 (10) :1860-1867

[10] The effect of methylene blue on the hemodynamic changes during ischemia reperfusion injury in orthotopic liver transplantation [J].

Koelzow, H ;

Gedney, JA ;

Baumann, J ;

Snook, NJ ;

Bellamy, MC .

ANESTHESIA AND ANALGESIA, 2002, 94 (04) :824-829

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