Recommended Citation
Kelly S, Ball E, Gavrilos G. Use of Methylene Blue in Refractory Shock and its Impact on Vasopressor Requirements. Presented at Scientific Day; May 21, 2025; Park Ridge, IL.
Abstract
Background/Significance:
Refractory shock has been defined as the requirement of high-dose vasopressors to attain hemodynamic targets and is associated with a high rate of mortality. Methylene blue is used by some providers as an adjunct to vasopressors for the treatment of refractory shock. Lack of established guidance and variability of use between providers has created a need to determine if there is a benefit to adding this drug to standard vasopressor therapy.
Purpose:
The objective of this project is to determine if treatment with methylene blue decreases vasopressor requirements in patients experiencing refractory shock.
Methods:
This single-center, retrospective review of current practice assessed patients admitted to the Advocate Christ Medical Center medical intensive care unit (ICU) for the management of shock between August 1, 2022, and December 31, 2024. A report generated from the electronic health record was used to identify potential patients, and patients were evaluated for inclusion in this study if they were at least 18 years of age and received at least 2 concomitant vasopressors. Peri- or post-operative patients were excluded. A search of medication orders for methylene blue was used to identify patients in the intervention group, and all patients that met eligibility criteria were included. An equal number of control patients were enrolled to match the intervention group. The primary endpoint was vasopressor-free days at 28 days. Secondary endpoints included ICU length-of-stay, hospital length-of-stay, mortality at 28 days, and mortality within 4 hours. Additional data points collected included demographic information, dose of methylene blue, time hospitalized prior to methylene blue administration, change in vasopressor requirements following methylene blue administration, dose of vasopressors in norepinephrine equivalents, administration of adjunctive therapies, administration of fluid resuscitation within 24 hours, and positive microbiological cultures.
Results:
A total of 77 patients were included, with 38 patients in the methylene blue group and 39 patients in the control group. Median vasopressor-free days at 28 days were decreased for methylene blue at 0.10 days versus 0.21 days for control (p=0.328). Length-of-stay was shorter in the methylene group than the control group at 7.33 days versus 9.98 days for hospital (p=0.474) and 2.78 days versus 3.52 days for ICU (p=0.276). Mortality at 28 days was similar between groups at 76.32% for methylene blue and 76.92% for control (p>0.99). 2 patients died within 4 hours of vasopressor initiation in the methylene blue group, compared to 0 patients in the control group (p=0.157).
Conclusion:
Administration of methylene blue was not associated with a change in vasopressor-free days compared to standard shock management. Further research regarding appropriate dosing and timing of initiation is necessary to determine the role in therapy of methylene blue for refractory shock.
Presentation Notes
Presented at Scientific Day; May 21, 2025; Park Ridge, IL.
Full Text of Presentation
wf_yes
Document Type
Poster
Use of Methylene Blue in Refractory Shock and its Impact on Vasopressor Requirements
Background/Significance:
Refractory shock has been defined as the requirement of high-dose vasopressors to attain hemodynamic targets and is associated with a high rate of mortality. Methylene blue is used by some providers as an adjunct to vasopressors for the treatment of refractory shock. Lack of established guidance and variability of use between providers has created a need to determine if there is a benefit to adding this drug to standard vasopressor therapy.
Purpose:
The objective of this project is to determine if treatment with methylene blue decreases vasopressor requirements in patients experiencing refractory shock.
Methods:
This single-center, retrospective review of current practice assessed patients admitted to the Advocate Christ Medical Center medical intensive care unit (ICU) for the management of shock between August 1, 2022, and December 31, 2024. A report generated from the electronic health record was used to identify potential patients, and patients were evaluated for inclusion in this study if they were at least 18 years of age and received at least 2 concomitant vasopressors. Peri- or post-operative patients were excluded. A search of medication orders for methylene blue was used to identify patients in the intervention group, and all patients that met eligibility criteria were included. An equal number of control patients were enrolled to match the intervention group. The primary endpoint was vasopressor-free days at 28 days. Secondary endpoints included ICU length-of-stay, hospital length-of-stay, mortality at 28 days, and mortality within 4 hours. Additional data points collected included demographic information, dose of methylene blue, time hospitalized prior to methylene blue administration, change in vasopressor requirements following methylene blue administration, dose of vasopressors in norepinephrine equivalents, administration of adjunctive therapies, administration of fluid resuscitation within 24 hours, and positive microbiological cultures.
Results:
A total of 77 patients were included, with 38 patients in the methylene blue group and 39 patients in the control group. Median vasopressor-free days at 28 days were decreased for methylene blue at 0.10 days versus 0.21 days for control (p=0.328). Length-of-stay was shorter in the methylene group than the control group at 7.33 days versus 9.98 days for hospital (p=0.474) and 2.78 days versus 3.52 days for ICU (p=0.276). Mortality at 28 days was similar between groups at 76.32% for methylene blue and 76.92% for control (p>0.99). 2 patients died within 4 hours of vasopressor initiation in the methylene blue group, compared to 0 patients in the control group (p=0.157).
Conclusion:
Administration of methylene blue was not associated with a change in vasopressor-free days compared to standard shock management. Further research regarding appropriate dosing and timing of initiation is necessary to determine the role in therapy of methylene blue for refractory shock.
Affiliations
Advocate Christ Medical Center