- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04250389
Microcirculatory Effects of Methylene Blue (MAGIC BLUE)
Microcirculatory Effects of Methylene Blue in Vasoplegic Shock After Cardiopulmonary Bypass: a Pilot Study
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).
Study Overview
Status
Conditions
Intervention / Treatment
Study Type
Enrollment (Actual)
Contacts and Locations
Study Locations
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Bron, France, 69500
- Service d'anesthesie reanimation, Hôpital cardiologique Louis Pradel
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Description
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
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
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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).
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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 :
Microcirculatory parameters will include :
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
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Change in tissue oxygenation (resaturation speed expressed as %/sec) during the vessel obstruction test.
Time Frame: one hour after the start of methylene blue infusion
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The resaturation speed during reperfusion is defined as maximum StO2 - minimum StO2 /time of reperfusion.
Tissue oxygen saturation (StO2) will be measured by near-infrared reflectance spectroscopy (NIRS) optode applied to the medial surface of the left or right forearm, 5 cm below the elbow.
The sensor will be connected to the four-wavelength O3 Regional Oximetry device (Masimo Incorporation).
All StO2 values will be recorded continuously and read every second.
Data will be recorded online, transferred to a laptop with a specific software designed by Masimo (Masimo Instrument Configuration Tool (MICT) Version 1.0.4.9), and stored for further analysis.
After completion of a baseline set of measurements for each patient, a vascular occlusion test (VOT) will be then perform using a manual pneumatic cuff inflator (Spengler SAS, Antony, France) positioned at the upper extremity of the ipsilateral upper limb.
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one hour after the start of methylene blue infusion
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
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Video microscopy measurements of the sublingual microcirculation
Time Frame: one hour after the start of methylene blue infusion
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Proportion of Perfused Vessel (PPV), Total Vessel Density (TVD), Perfused Vessel Density (PVD), Microcirculatory Flow Index (MFI) and heterogeneity index will be reported.
Video microscopy measurements will be collected before and one hour after the beginning of MB infusion.
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one hour after the start of methylene blue infusion
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Cutaneous and gingival refill time
Time Frame: one hour after the start of methylene blue infusion
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Five consecutive cutaneous recoloration time (CRT) acquisitions on the thorax and five consecutive gingival recoloration time (GRT) acquisitions will be made after calibrated compression of the skin and the gingiva.
These measurements will be collected before and one hour after the beginning of MB infusion.
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one hour after the start of methylene blue infusion
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Metabolic variables
Time Frame: one hour after the start of methylene blue infusion
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Arterial blood gases including arterial lactate and central venous blood gases will be withdrawn before and one hour after the beginning of MB infusion concomitantly to measurement of cardiac output to allow calculation of oxygen delivery (DO2), oxygen uptake (VO2), oxygen extraction ratio (ER), venous-to-arterial difference in carbon dioxide partial pressure (PCO2gap), modified respiratory quotient (RQ modified) and ratio of central venous-to-arterial carbon dioxide content to arteriovenous oxygen content (DavCO2/DavO2).
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one hour after the start of methylene blue infusion
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Collaborators and Investigators
Sponsor
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2019_MAGICBLUE
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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