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Document Type

DNP Project




Background: Millions of individuals are affected by cardiovascular disease (CVD). Many of these require surgical intervention; some of which undergo cardiopulmonary bypass (CPB). Unfortunately, refractory hypotension is a common occurrence when CPB is utilized; which leads to increased morbidity and mortality. Aim: The traditional treatment for post-CPB vasoplegia is high doses of vasopressors, but this treatment option has been proven to be associated with tissue ischemia. The purpose of this scholarly project is to determine if prophylactic administration of Methylene Blue (MB) is a viable treatment option for post-CPB vasoplegia, as MB can prevent smooth muscle vasodilation while avoiding the adverse effects of vasopressors at high doses. Results: MB appears to be a promising treatment option for the refractory hypotension that can follow the post-CPB period due to its ability to disrupt the Nitric Oxide pathway. Discussion: Methylene Blue has proven to be an effective treatment for refractory hypotension after the discontinuation of CPB on various cases, and it has a wide margin of safety. However, most of its use is limited to last-line rescue therapy rather than prophylaxis. Educational Project: An educational module was created to challenge conventional clinical thinking. An informative PowerPoint presentation was disseminated to anesthesia providers along with a Pre-Test to assess baseline knowledge, and a Post-Test to determine if learning had occurred. Clinicians were also asked about their likelihood to incorporate MB into their practice.

Conclusion: Methylene Blue is an old drug with great new potential. However, the number of studies that focus on prophylaxis is limited. More research is necessary to establish new practice guidelines that could provide great benefit to a large patient population.



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