Methylene blue: Role in early management of septic shock patients?

Background The incidence of sepsis has increased steadily over the last three decades. Aggressive fluid challenge and administration of catecholamines still play a vital role in the current treatment regimen of patients with septic shock. However, new methods and drugs are needed for better management. Objective The aim of the study was to evaluate the role of early intervention with continuous infusion of methylene blue in management of septic shock patients regarding hemodynamics, duration of septic shock, and vasopressor support. Patients and methods Forty patients fulfilling the criteria of septic shock were randomized into two groups: group 1 that received methylene blue bolus at a dose of 1 mg/kg followed after 2 h by infusion at 0.5 mg/kg/h for 4 h and group 2 that received normal saline. Results The results were favorable in the study group, which showed higher and better mean arterial blood pressure, systemic vascular resistance, and cardiac output and less need for inotropes reflected by the lower length of ICU stay. Conclusion It can be concluded that the early application of methylene blue (defined by the need for norepinephrine at a dose of at least 0.2 μg/kg/min required to maintain mean arterial blood pressure between 70 and 90 mmHg) at a dose of 1 mg/kg bolus followed by 0.5 mg/kg/h for 4 h showed favorable effects on hemodynamics of cardiac output, decreasing the length of hospital stay.