The pharmacotherapeutic options in patients with catecholamine-resistant vasodilatory shock

Albertson, Timothy E; Chenoweth, James A.; Lewis, Justin; Pugashetti, Janelle Vu; Sandrock, Christian; Morrissey, Brian M.

doi:10.1080/17512433.2022.2110067

Cited by 2 publications

(3 citation statements)

References 175 publications

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“…MB is a non-expensive and widely available molecule, which has been most commonly used to treat severe methemoglobinemia in the context of poisoning. When administered intravenously, MB has an onset of action of 30-60 min with a terminal plasma half-life of 5-6 h [23,24]. It is metabolized by the liver and excreted primarily by the kidneys, so that patients with dysfunction of these organs have a higher risk of toxicity and drug interactions through cytochrome P450 inhibition [23].…”

Section: Nitric Oxide Inhibitorsmentioning

confidence: 99%

“…MB is generally well tolerated and toxicity is dose related; blue-green discoloration of urine, skin, and secretions is commonly described, which can interfere with the accuracy of pulse oximeter readings. More severe adverse effects, such as mesenteric vasoconstriction and paradoxical methemoglobinemia, have been reported with higher doses up to 4 mg/kg [24]. Inhibition of monoamine oxidase A by MB can induce a serotonin syndrome.…”

Section: Nitric Oxide Inhibitorsmentioning

confidence: 99%

“…[31]. Two recent meta-analyses included the study by Ibarra-Estrada et al [24]. In a meta-analysis of 11 randomized controlled trials in perioperative or critically ill patients, Pruna et al [32] suggested that MB administration may be associated with improved hemodynamics, reduced ICU and hospital lengths of stay, and lower mortality (relative risk 0.60 [95% CI, 0.43-0.84]; p = 0.003), while in a meta-analysis of 6 randomized controlled trials assessing MB use in patients with distributive shock, Huang et al reported reduced duration of mechanical ventilation and hospital length of stay in MB-treated patients, but no effect on mortality [33].…”

Section: Nitric Oxide Inhibitorsmentioning

confidence: 99%

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Administration of methylene blue in septic shock: pros and cons

Arias-Ortiz,

Vincent

2024

Crit Care

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Septic shock typically requires the administration of vasopressors. Adrenergic agents remain the first choice, namely norepinephrine. However, their use to counteract life-threatening hypotension comes with potential adverse effects, so that non-adrenergic vasopressors may also be considered. The use of agents that act through different mechanisms may also provide an advantage. Nitric oxide (NO) is the main driver of the vasodilation that leads to hypotension in septic shock, so several agents have been tested to counteract its effects. The use of non-selective NO synthase inhibitors has been of questionable benefit. Methylene blue, an inhibitor of soluble guanylate cyclase, an important enzyme involved in the NO signaling pathway in the vascular smooth muscle cell, has also been proposed. However, more than 25 years since the first clinical evaluation of MB administration in septic shock, the safety and benefits of its use are still not fully established, and it should not be used routinely in clinical practice until further evidence of its efficacy is available.

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Section: Nitric Oxide Inhibitorsmentioning

confidence: 99%

Section: Nitric Oxide Inhibitorsmentioning

confidence: 99%

Section: Nitric Oxide Inhibitorsmentioning

confidence: 99%

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Administration of methylene blue in septic shock: pros and cons

Arias-Ortiz,

Vincent

2024

Crit Care

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Methylene Blue for Septic Shock: A Systematic Review and Meta-analysis of Randomized and Prospective Observational Studies

Alkazemi,

Almoosawy,

Murad

et al. 2024

J Intensive Care Med

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Background The impact of methylene blue (MB) on critical patient outcomes, including overall mortality, hemodynamic stability, and organ function has been inconsistently described across studies. This study aims to evaluate the efficacy of MB therapy in adult patients with septic shock in the intensive care unit (ICU). Methods The systematic search of PubMed/MEDLINE, EMBASE and Cochrane Library databases up to February 2024 included randomized controlled trials and prospective observational studies involving adult septic shock patients who received intravenous MB therapy. The primary outcome was all-cause mortality, with secondary outcomes on hemodynamics and ICU length of stay. Results Fifteen studies (5 randomized, 10 non-randomized) involving a total of 441 patients, met the inclusion criteria. The meta-analysis showed statistically significant reduction in mortality rates among septic shock patients treated with MB (mortality rate 0.52; 95% CI 0.38 to 0.66; P < .001). In a sub-analysis of only randomized trials, the results remained statistically significant (risk ratio 0.66; 95% CI 0.47 to 0.94; P = .023). A significant increase in mean arterial pressure post-infusion was observed in three studies. Two studies showed no substantial difference in heart rate and two studies showed no difference in cardiac index following MB administration. Only one study showed a reduction in the length of ICU stay with MB use, while another observed a decrease in overall hospital length of stay. Conclusions The review and meta-analysis suggest that MB may be associated with a significant reduction in mortality in septic shock patients though findings are limited by sample size and heterogeneity. Further robust studies are needed to validate these results.

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The pharmacotherapeutic options in patients with catecholamine-resistant vasodilatory shock

Cited by 2 publications

References 175 publications

Administration of methylene blue in septic shock: pros and cons

Administration of methylene blue in septic shock: pros and cons

Methylene Blue for Septic Shock: A Systematic Review and Meta-analysis of Randomized and Prospective Observational Studies

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