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Evaluating the Change in Vasopressor Requirements in Patients with Septic Shock Receiving Methylene Blue
Thursday April 24, 2025 3:10pm - 3:25pm EDT
Athena H
  1. Title: Effect of Methylene Blue on Vasopressor Requirements in Patients with Septic Shock
  2. Resident Email: taylor.dodd2@hcahealthcare.com
  3. Authors: Taylor Dodd, Stephanie Lesslie
  4. Background: Septic shock is defined as a severe infection causing an abnormal immune response with the potential to progress to hypotension and organ failure. Vasopressors may be required to achieve mean arterial pressures sustainable to life. Methylene blue has shown promising data in improving hemodynamics through the inhibition of nitric oxide, a vasodilator released by the body in a shocked state. A 2023 trial found that early methylene blue administration in septic shock led to earlier vasopressor discontinuation and shorter hospital durations. Other studies have been conducted that have shown a reduction in vasopressor requirements and increased survival rates with the addition of methylene blue.    
  5. Methods: This single-center, retrospective cohort study aimed to assess the change in vasopressor requirements in patients with septic shock that received methylene blue. Patients were included if they were 18 years old, admitted to the emergency department or intensive care unit at time of methylene blue administration, and used for the indication of sepsis or septic shock. Patients were excluded if they had contraindications to methylene blue, were pregnant, or incarcerated. The primary outcome was the change in vasopressor requirements 12 hours after administration of methylene blue. The secondary outcomes investigated were change in vasopressor requirements 6 and 24 hours after methylene blue administration, hospital and ICU length of stay, total number of methylene blue doses, mortality, and reported adverse effects.
  6. Results: 
    In this descriptive study, 38 patients met inclusion criteria; 2 of which were excluded from this study. For the excluded patients, 1 was incarcerated and the other had a creatinine clearance < 15 mL/min. For the primary outcome of change in vasopressors 12 hours after methylene blue administration, we observed a decrease in vasopressor requirements of 17.5 mcg/minute, reported in norepinephrine equivalents.
    At the 6 hour time point after methylene blue administration, we observed a decrease in vasopressor requirements of 2.5 mcg/minute. There was a decrease in vasopressor requirements observed 24-hours after methylene blue administration of 14.0 mcg/minute. In the patients included, there was an all-cause mortality rate of 78%. The median ICU length of stay was 4 days and the median hospital length of stay was 5 days in patients that received methylene blue. There were no reported adverse effects reported in patients who received methylene blue.
  7. Conclusion: Overall, our study observed that patients who received methylene blue had decreased vasopressor requirements at 6, 12 and 24 hours after administration. No adverse effects were identified.
Moderators
JC

John Carr

PGY2 RPD Critical Care, SJCHS
Presenters
avatar for Taylor Dodd

Taylor Dodd

PGY1 Pharmacy Resident, Memorial Health University Medical Center
My name is Taylor Dodd and I am a PGY1 pharmacy resident at Memorial Health University Medical Center in Savannah, Georgia. I graduated from University of South Carolina College of Pharmacy in 2024. I will be completing a critical care PGY2 at Memorial Health University Medical Center... Read More →
Evaluators
KR
Thursday April 24, 2025 3:10pm - 3:25pm EDT
Athena H
  Critical Care/Emergency Medicine (CCM), Memorial Health University Medical Center
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