AUTHOR=Ballarin Raquel Simões , Lazzarin Taline , Zornoff Leonardo , Azevedo Paula Schmidt , Pereira Filipe Welson Leal , Tanni Suzana Erico , Minicucci Marcos Ferreira 

TITLE=Methylene blue in sepsis and septic shock: a systematic review and meta-analysis

JOURNAL=Frontiers in Medicine

VOLUME=Volume 11 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2024.1366062

DOI=10.3389/fmed.2024.1366062

ISSN=2296-858X

ABSTRACT=Background: Methylene blue is an interesting approach to reducing fluid overload and vasoactive drug administration in vasodilatory shock. The inhibition of guanylate cyclase induce by methylene blue infusion reduces nitric oxide production and improves vasoconstriction. This systematic review and meta-analysis aimed to assess the effects of methylene blue administration compared to placebo on the hemodynamic status and clinical outcomes in patients with sepsis and septic shock.The authors specifically included randomized controlled trials that compared the use of methylene blue with placebo in adult patients with sepsis and septic shock.The outcomes were length of intensive care unit stay, hemodynamic parameters [vasopressors use and days on mechanical ventilation]. We also evaluated the abnormal levels of methemoglobinemia. This systematic review and meta-analysis were recorded in PROSPERO with the ID CRD42023423470.Results: 1,014 records were identified in the initial search, and 393 were duplicates. Fourteen citations were selected for detailed reading, and three were selected for inclusion. The studies enrolled 141 patients, 70 in methylene blue and 71 in the control group. Methylene blue treatment was associated with a lower length of intensive care unit stay (MD -1.58; 95%CI -2.97, -0.20; I² = 25%; p = 0.03), decreased days on mechanical ventilation (MD -0.72; 95%CI -1.26, -0.17; I² = 0%; p = 0.010) and shorter time to vasopressor discontinuation (MD -31.49; 95%CI -46.02, -16.96; I² = 0%; p < 0.0001). No association was found with methemoglobinemia.Conclusions: Administering methylene blue to patients with sepsis and septic shock leads to reduced time to vasopressor discontinuation, length of intensive care unit stay and days on mechanical ventilation.