Methylene blue as a treatment for refractory shock: An analysis of analytic studies

Abstract

Vasoplegia is observed in different types of shock and in post-surgical states it has few treatment alternatives, so the use of methylene blue has been proposed as a coadjuvant therapy, but the indications for its use are not adequately established. Databases (PubMed, Ebscohost, Scopus, Cochrane and Lilacs) were searched for analytical studies evaluating the use of methylene blue (MB) in adult patients with refractory shock compared to standard therapy, to show the possible benefit of its use in these Seven studies were included, 3 clinical trials and 4 cohorts, in the context of septic shock and refractory shock after cardiac surgery. All studies show an increase in mean arterial pressure, with a decrease in the use of vasopressors after the administration of methylene blue; in addition to lower morbidity and mortality, except in those studies with heterogeneous groups. Therefore, methylene blue can be considered as adjuvant therapy in patients with distributive shock refractory to vasopressors in the setting of sepsis or cardiac surgery. © 2024 Sociedad de Anestesiologia de Chile. All rights reserved.