naa a22 4500 510744753 CHVBK 20180411083042.0 cr unu---uuuuu 180411e20131101xx s 000 0 eng 10.1007/s12630-013-0026-4 doi (NATIONALLICENCE)springer-10.1007/s12630-013-0026-4 A case of acute respiratory distress syndrome responsive to methylene blue during a carcinoid crisis [Elektronische Daten] [Sean van Diepen, Alan Sobey, Richard Lewanczuk, Gurmeet Singh, Surita Sidhu, Mohamad Zibdawi, John Mullen] Un cas de syndrome de détresse respiratoire aiguë répondant au bleu de méthylène pendant une crise carcinoïde Purpose: In a carcinoid crisis, numerous vasoactive agents, such as bradykinin precursors, serotonin, and histamine, are secreted by tumour cells. Bradykinin has been shown to increase pulmonary vascular permeability and hypotension in animal models; however, little is known about its in vivo effects or targeted pharmacotherapy in a carcinoid crisis. We describe a case of acute respiratory distress syndrome (ARDS) in a carcinoid crisis refractory to conventional antiserotonin and antihistamine therapies. Clinical features: A 56-yr-old male with known liver metastases and previous resection of a small intestinal carcinoid tumour in 1991 underwent successful tricuspid and pulmonary valve replacements. On postoperative day 10, he developed hypotension, a fever, leukocytosis, and flushing. His hypotension was treated with a 200μg octreotide iv bolus followed by a 150μg·hr−1 infusion, vasopressin, norepinephrine, and hydrocortisone. He also required tracheal intubation for ARDS (Pa02:FI02 ratio 96). After 72hr of broad spectrum antibiotics and no clinical improvement, antiserotonin and antihistamine therapies were augmented with cyproheptadine, ranitidine, and serial octreotide boluses with an infusion of 1,500μg·hr−1. These interventions improved his oxygenation (Pa02:F i 02 ratio 162) and reducedhis norepinephrine requirements. Following a methylene blue bolus (1mg·kg−1) and 12-hr infusion (0.5mg·kg−1·hr−1), all vasopressors were discontinued and his oxygenation improved (Pa02:F i 02 ratio 297). Conclusion: In a patient with a carcinoid crisis and ARDS refractory to conventional therapies, substantial hemodynamic and oxygenation improvements were observed following methylene blue administration. This case highlights the potential pathophysiologic role of bradykinin and methylene blue as an adjunct therapeutic option in carcinoid crises. Canadian Anesthesiologists' Society, 2013 van Diepen Sean Divisions of Critical Care and Cardiology, University of Alberta, Edmonton, AB, Canada aut Sobey Alan Division of Critical Care, University of Alberta, Edmonton, AB, Canada aut Lewanczuk Richard Division of Endocrinology, University of Alberta, Edmonton, AB, Canada aut Singh Gurmeet Division of Critical Care, University of Alberta, Edmonton, AB, Canada aut Sidhu Surita Division of Anesthesia, University of Alberta, Edmonton, AB, Canada aut Zibdawi Mohamad Division of Critical Care, University of Alberta, Edmonton, AB, Canada aut Mullen John Division of Cardiothoracic Surgery, University of Alberta, Edmonton, AB, Canada aut Canadian Journal of Anesthesia/Journal canadien d'anesthésie Springer US; http://www.springer-ny.com 60/11(2013-11-01), 1085-1088 0832-610X 60:11<1085 2013 60 12630 https://doi.org/10.1007/s12630-013-0026-4 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12630-013-0026-4 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- van Diepen Sean Divisions of Critical Care and Cardiology, University of Alberta, Edmonton, AB, Canada aut NATIONALLICENCE 700 1- Sobey Alan Division of Critical Care, University of Alberta, Edmonton, AB, Canada aut NATIONALLICENCE 700 1- Lewanczuk Richard Division of Endocrinology, University of Alberta, Edmonton, AB, Canada aut NATIONALLICENCE 700 1- Singh Gurmeet Division of Critical Care, University of Alberta, Edmonton, AB, Canada aut NATIONALLICENCE 700 1- Sidhu Surita Division of Anesthesia, University of Alberta, Edmonton, AB, Canada aut NATIONALLICENCE 700 1- Zibdawi Mohamad Division of Critical Care, University of Alberta, Edmonton, AB, Canada aut NATIONALLICENCE 700 1- Mullen John Division of Cardiothoracic Surgery, University of Alberta, Edmonton, AB, Canada aut NATIONALLICENCE 773 0- Canadian Journal of Anesthesia/Journal canadien d'anesthésie Springer US; http://www.springer-ny.com 60/11(2013-11-01), 1085-1088 0832-610X 60:11<1085 2013 60 12630 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer