This review establishes a clinical framework for managing systemic inflammatory complications (aseptic-thermochemical shock) arising from hyperthermic intrathoracic chemotherapy in pleural cancer patients. The syndrome combines features of septic shock, vasoplegic syndrome, and burn injury, characterized by endothelial dysfunction, capillary leak, and hemodynamic instability. The authors propose a perioperative protocol including prophylactic hydration, nephroprotective agents, and selective use of methylene blue for refractory vasoplegia to mitigate complications and improve outcomes.
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Methylene blue is proposed for refractory vasoplegia in hyperthermic intrathoracic chemotherapy, offering a targeted option when standard vasopressors fall short.