Effect of methylene blue on hemodynamic response in the early phase of septic shock: A case series

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Luis-Silva, Fabio ; Menegueti, Mayra Goncalves ; Sato, Lucas ; Peres, Leandro Moreira ; Sepeda, Corina dos Reis ; Petroski-Moraes, Bruno C. ; Donadel, Mariana Derminio ; Gallo, Gabriela Bortoleto ; Jordani, Maria Cecilia ; Mestriner, Fabiola ; Becari, Christiane ; Basile-Filho, Anibal ; Evora, Paulo R. B. ; Martins-Filho, Olindo Assis ; Auxiliadora-Martins, Maria

• Document type: Journal article
• Source: MEDICINE; v. 102, n. 4, p. 7-pg., 2023-01-27.

Abstract

Rationale:Methylene blue (MB) has been used to increase blood pressure in septic shock, acting on the activity of guanylate cyclase and nitric oxide synthase. Patience concerns:The aim of this study is to demonstrate the benefit of MB in early phase of septic shock.Diagnoses: We report 6 cases of patients with septic shock with up to 72 hours of evolution. Interventions:We used MB after fluid replacement, use of norepinephrine and vasopressin. Patients received a loading dose of MB and maintenance for 48 hours. Outcomes:All patients presented a reduction in the dose of vasopressors and lactate levels soon after the administration of the loading dose of MB, an effect that was maintained with the maintenance dose for 48 hours. Interleukin 6 and interleukin 8 were elevated at the beginning of the septic condition, with a progressive and marked reduction after the beginning of MB infusion, demonstrating a role of MB in reducing the inflammatory activity. Lessons:This case series suggests that MB used early in the treatment of septic shock may be useful in reducing vasopressor dose and lactate levels. Further studies are still required to further validate these findings. (AU)

• FAPESP's process: 18/26553-0 - A randomized, placebo-controlled study evaluating the hemodynamic and metabolic effects of Methylene blue treatment in septic shock
• Grantee: Maria Auxiliadora Martins
• Support Opportunities: Regular Research Grants
• FAPESP's process: 17/21539-6 - Role of renin angiotensin system in Abdominal Aortic Aneurysm
• Grantee: Christiane Becari
• Support Opportunities: Research Grants - Young Investigators Grants
• FAPESP's process: 18/23718-8 - Role of renin angiotensin system in abdominal aortic aneurysm
• Grantee: Christiane Becari
• Support Opportunities: Scholarships in Brazil - Young Researchers
• FAPESP's process: 21/01195-6 - Evaluation of inflammatory mediators and nitric oxide in plasma of septic patients submitted to treatment with methylene blue
• Grantee: Bruno Cesar Petroski Moraes
• Support Opportunities: Scholarships in Brazil - Technical Training Program - Technical Training