Extended Continuous Infusion of Methylene Blue for Refractory Septic Shock

Jaiswal, Abhishek; Kumar, Manish; Silver, Elizabeth

doi:10.5005/jp-journals-10071-23376

Cited by 6 publications

(3 citation statements)

References 5 publications

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“…If the cases are treated with ECMO, the mortality rate will be up to 80% [11]. In accordance with some case reports [44], the clinically highest dosages of various vasopressor drugs and the prolonged MB infusion during the VV-ECMO treatment may reverse RSS.…”

Section: Application Of Ecmo In Combination With Methylene Blue (Mb) ...supporting

confidence: 64%

Extracorporeal membrane oxygenation for refractory septic shock in children

2024

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Children are susceptible to developing sepsis. Among its complications, septic shock is the most severe. Refractory septic shock (RSS) is defined as septic shock that is unresponsive to standard resuscitation. As the most severe complication of sepsis in children, refractory septic shock (RSS) is characterized by its rapid development and high mortality rate. In accordance with relevant guidelines and consensus, extracorporeal membrane oxygenation (ECMO) is recommended as a salvage therapy for the treatment of RSS in children. However, various controversies and difficulties still exists when ECMO is used to treat children with RSS. Thus, this review summarizes the current status, difficulties, and explorations of applying ECMO to the treatment of RSS in children.

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Section: Application Of Ecmo In Combination With Methylene Blue (Mb) ...supporting

confidence: 64%

Extracorporeal membrane oxygenation for refractory septic shock in children

2024

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“…Although a multitude of experimental studies have documented favorable hemodynamic effects, the clinical evidence supporting the use of MB is predominantly derived from case reports, small observational studies, and a limited number of controlled trials. 12 , 13 Despite the observed improvements in MAP and systemic vascular resistance (SVR) following the administration of MB, the evidence supporting a statistically significant improvement in survival outcomes remains inconclusive. 10 , 14 – 16 …”

Section: Discussionmentioning

confidence: 99%

Can Use of Intravenous Methylene Blue Improve the Hemodynamics and Outcome of the Patients with Refractory Septic Shock? An Observational Study

Rajbanshi,

Arjyal,

Bajracharya

et al. 2023

Indian Journal of Critical Care Medicine

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A bstract Introduction Refractory shock, which fails to respond to conventional vasopressor therapy, is a common complication of sepsis. Methylene blue has emerged as a potential adjunctive treatment option for reversing refractory shock in sepsis. The aim of this study was to evaluate the impact of intravenous methylene blue infusion on hemodynamic improvement and mortality in patients with refractory shock. Methodology This was an observational prospective study for the duration of six months conducted at intensive care a medical college and teaching hospital including 76 patients with a diagnosis of septic shock requiring vasopressor therapy. Intravenous (IV) methylene blue was infused as a bolus dose with 2 mg/kg dose in 20 minutes and its response to mean arterial blood pressure, decrease in vasopressor therapy, lactate level, and urine output was recorded in next 2 hours. Patients with improvement in mean arterial pressure (MAP) by 10% or decrease in vasopressor therapy in the next 2 hours were leveled as responder. The length of intensive care unit (ICU) stay, duration of mechanical ventilation, incidence of acute kidney injury (AKI), and mortality were compared between responder and non-responder. Results A total of 76 patients with refractory shock were included in the study. With the use of IV methylene blue, 41 (53.9%) patients showed significant improvement in MAP within 2 hours (70.17 ± 8.30 vs 64.28 ± 11.84, p = 0.005). Responders were 4.019 times more likely to have vasopressor-free time within 24 hours (18.4% vs 5.3%, p = 0.020, odds ratio 4.019, 95% confidence interval, 1.180–13.682). However, there was no significant difference in terms of mortality, length of ICU stay, ventilator free days, and incidence of AKI. In the responder group, there was a significant increase in the MAP and decrease in vasopressor requirement pre- and post-infusion of methylene blue ( p < 0.05). Responder had shorter vasopressor-free days as compared with non-responder (5.34 vs 6.79, p = 0.008) while the mean survival time was longer with responders (21.97 vs 15.93 days, p = 0.024). Conclusion The use of IV methylene blue in refractory shock as an adjuvant therapy significantly improved the mean arterial blood pressure and decreased the requirement of vasopressor therapy as well as improvement in the survival time. However, there was no change in the mortality, length of ICU stay, ventilator-free days, or incidence of AKI in the patients. How to cite this article Rajbanshi LK, Bajracharya A, Arjyal B, Devkota D. Can Use of Intravenous Methylene Blue Improve the Hemodynamics and Outcome of the Patients with Refractory Septic Shock? An Observational Study. Indian J Crit Care Med 2023;27(9):669–674.

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“…Patients are always closely monitored for any potential adverse effects in RCTs, and although our results could be considered as reassuring, we recognize the importance of post-marketing drug safety surveillance in real-world settings, and urge clinicians to strictly adhere to specifications of manufacturers along with local pharmacy department policies. Notwithstanding, we would like to pinpoint other pharmacokinetic/pharmacodynamic factors that could have improved the efficacy of MB in our trial even more than the use of NS; namely, an initial 1 mg/kg bolus [ 10 ], doses of 2–3 mg/kg instead of fixed 100 mg [ 11 – 13 ], continuous infusion [ 4 , 14 ], repeated doses until shock resolution instead of a fixed 3-doses scheme, and especially, aiming for an earlier administration after septic shock diagnosis, as it has been suggested that efficacy could be enhanced if MB is used within the first 8 h [ 15 ].…”

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confidence: 99%

Drug diluent and efficacy of methylene blue in septic shock: authors’ reply

Ibarra-Estrada,

Kattan,

Aguirre-Avalos

et al. 2023

Crit Care

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Extended Continuous Infusion of Methylene Blue for Refractory Septic Shock

Cited by 6 publications

References 5 publications

Extracorporeal membrane oxygenation for refractory septic shock in children

Extracorporeal membrane oxygenation for refractory septic shock in children

Can Use of Intravenous Methylene Blue Improve the Hemodynamics and Outcome of the Patients with Refractory Septic Shock? An Observational Study

Drug diluent and efficacy of methylene blue in septic shock: authors’ reply

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