Use of Methylene Blue in Sepsis: A Systematic Review

Kwok, Edmund; Howes, Daniel

doi:10.1177/0885066606290671

Cited by 126 publications

(120 citation statements)

References 34 publications

(25 reference statements)

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“…Its pharmacologic mechanism of effect and previous descriptions in sepsis literature [15][16][17] support its use in vasodilatory shock from calcium channel blocker poisoning. Septic shock is associated with excess nitric oxide production which in turn stimulates soluble guanylyl cyclase (cGMP) to increase endothelial smooth muscle relaxation [15].…”

Section: Discussionmentioning

confidence: 59%

Improvement in Hemodynamics After Methylene Blue Administration in Drug-Induced Vasodilatory Shock: A Case Report

Laes

Williams

Cole³

2015

J. Med. Toxicol.

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Introduction The purpose of this study is to describe a case where methylene blue improved hemodynamics in a poisoned patient.Case Report This is a single case report where a poisoned patient developed vasodilatory shock following ingestion of atenolol, amlodipine, and valsartan. Shock persisted after multiple therapies including vasopressors, high-dose insulin, hemodialysis, and 20% intravenous fat emulsion. Methylene blue (2 mg/kg IV over 30 min) was administered in the ICU with temporal improvement as measured by pulmonary artery catheter hemodynamic data pre-and post-methylene blue administration. Within 1 h of methylene blue administration, systemic vascular resistance improved (240 dyn s/cm5 increased to 1204 dyn s/cm5), and vasopressor requirements decreased with maintenance of mean arterial pressure 60 mmHg. Discussion Methylene blue may improve hemodynamics in drug-induced vasodilatory shock and should be considered in critically ill patients poisoned with vasodilatory medications refractory to standard therapies.

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Section: Discussionmentioning

confidence: 59%

Improvement in Hemodynamics After Methylene Blue Administration in Drug-Induced Vasodilatory Shock: A Case Report

Laes

Williams

Cole³

2015

J. Med. Toxicol.

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“…Methylene blue has been used over the last several years as a treatment for intractable hypotension in anaphylaxis, sepsis, and vasoplegia from cardiopulmonary bypass during cardiac surgery [32][33][34][35]. Multiple case reports document the reversal of anaphylactic symptoms, including druginduced cardiac arrest and angioedema, after patients receive methylene blue [36][37][38].…”

Section: Discussionmentioning

confidence: 99%

Anaphylaxis with Latrodectus Antivenin Resulting in Cardiac Arrest

Murphy

Hong

Beuhler³

2011

J. Med. Toxicol.

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Latrodectus mactans antivenin is a safe and effective therapy for severe black widow spider envenomations when given to most patients. We report a case of a 37-year-old male with a history of asthma that was given L. mactans antivenin for symptoms related to a black widow envenomation and developed a severe anaphylactic reaction resulting in cardiac arrest. When traditional therapies failed, the patient was given methylene blue for anaphylactic shock resulting in a 30-h period of hemodynamic stability. Despite initial resuscitation, the patient ultimately died 40 h after presentation. Under the right circumstances, L. mactans antivenin remains a safe and effective therapy for severe black widow envenomations. However, anaphylaxis is a risk for those receiving this therapy, even when the antivenin is diluted and given as an infusion. We report the first death related to diluted L. mactans antivenin given as an infusion.

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“…In this case, we report the need for a prolonged infusion of MB over a period of 120 hr in a patient with intractable septic shock. Previous research has demonstrated that MB may be efficacious in septic shock when given by intravenous bolus or short-term (B6 h) infusions, 3,4,9,11,[16][17][18] although a case report of a longer-term infusion of 44 hr has been described. 12 Despite standard treatment for septic shock with early goal-directed therapy, conventional vasopressors, including norepinephrine, epinephrine, and vasopressin, our patient responded only to the administration of MB.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5][6][7][8][9][10][11][12] Little is known about the clinical utility, optimal dose, or duration of MB administration in patients with septic shock. The relatively few reports available on the use of MB in septic shock describe relatively short infusions.…”

Section: Résumémentioning

confidence: 99%

Prolonged methylene blue infusion in refractory septic shock: a case report

Dumbarton

Minor

Yeung

et al. 2011

Can J Anesth/J Can Anesth

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Purpose Methylene blue (MB) has been advocated for the treatment of refractory hemodynamic instability in patients with septic shock. However, the use of MB infusions in septic shock is not considered standard treatment, and the available literature describes infusions of short duration, typically less than six hours. Clinical features We report a case of septic shock in a 67-yr-old male who required maximal vasopressor support with norepinephrine, epinephrine, and vasopressin. Despite standard protocols for the treatment of septic shock, the patient's hemodynamic status was refractory 80 hr post admission. However, initiation of a MB infusion resulted in the rapid restoration of hemodynamic stability and a subsequent decrease in vasopressor requirements.Multiple attempts to discontinue the MB infusion resulted in immediate and repeated increases in vasopressor requirements, necessitating a continuous infusion with a slow taper of MB for 120 hr. Ultimately, the patient survived the illness and was discharged home. We observed no adverse events that could be attributed to the use of MB. Conclusion In our patient, the use of MB resulted in hemodynamic stability unattained with standard vasopressor support. Further research is warranted on the use of MB in patients with septic shock. RésuméObjectif Le bleu de me´thyle`ne (BM) a e´te´propose´par certains chercheurs comme traitement de l'instabiliteh e´modynamique re´fractaire chez les patients en choc septique. La perfusion de BM n'est toutefois pas conside´re´e comme un traitement standard du choc septique, et la litte´rature publie´e de´crit des perfusions de courte dure´e, en ge´ne´ral de moins de six heures. É léments cliniques Nous rapportons un cas de choc septique chez un homme de 67 ans qui a eu besoin d'un soutien vasopresseur maximal avec de la nore´pine´phrine, de l'e´pine´phrine et de la vasopressine. Malgre´l'application des protocoles normalise´s pour le traitement du choc septique, l'e´tat he´modynamique du patient demeurait re´fractaire 80 h apre`s son admission. L'amorce d'une perfusion de BM a toutefois permis de re´tablir rapidement la stabilite´he´modynamique du patient et a entraıˆne´une re´duction subse´quente de ses besoins en vasopresseurs. Les nombreuses tentatives d'interruption de la perfusion de BM ont entraıˆne´des augmentations imme´diates et re´pe´te´es des besoins en vasopresseurs, c'est pourquoi une perfusion continue a`un de´bit plus bas de BM durant 120 h a e´te´mise en place. Le patient a finalement surve´cu a`la maladie et reçu son conge´de l'hôpital. Nous

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Use of Methylene Blue in Sepsis: A Systematic Review

Cited by 126 publications

References 34 publications

Improvement in Hemodynamics After Methylene Blue Administration in Drug-Induced Vasodilatory Shock: A Case Report

Improvement in Hemodynamics After Methylene Blue Administration in Drug-Induced Vasodilatory Shock: A Case Report

Anaphylaxis with Latrodectus Antivenin Resulting in Cardiac Arrest

Prolonged methylene blue infusion in refractory septic shock: a case report

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