Taryn Scott, PharmD, BCPPS
PICU Clinical Specialist
Norton Children's Hospital, United States
Disclosure information not submitted.
Lisa Infanti, PharmD, BCCCP
PICU Pharmacist
Norton Children's Hospital, United States
Disclosure information not submitted.
Title: Use of Methylene Blue for Pediatric Shock in a Mixed Pediatric Intensive Care Unit
Introduction: Distributive shock is a common condition seen in critically ill pediatric patients which may lead to uncontrolled vasodilation. Methylene blue has been used as a catecholamine sparing agent for patients with shock or vasoplegia syndromes that are refractory to standard therapy. There is limited pediatric data assessing the safety and efficacy of methylene blue for this indication. The purpose of this study is to evaluate the use of methylene blue for refractory shock or vasoplegia syndromes at a freestanding children's hospital.
Methods: This study was a single center retrospective chart review evaluating methylene blue for refractory shock or vasoplegia syndrome in a mixed pediatric intensive care unit (PICU) between June 2015 and September 2020. Patients were excluded if they were older than 18 years of age or received methylene blue for a diagnostic procedure. Data abstracted for analysis included demographics, timing and dose of methylene blue and 30 day mortality. Hemodynamic measurements were collected at baseline and subsequent 1 hour intervals until 6 hours post administration. Doses of vasopressors before methylene blue and 3 and 6 hours post administration were obtained.
Results: In total 24 patients with 33 total methylene blue administrations were included in the final analysis. There were 18 doses given for refractory shock and 15 doses given for vasoplegia syndrome. The average increase in systolic and diastolic blood pressure was 6 mmHg (+13.2 mmHg), and 5 mmHg (+7.8 mmHg) respectively. There was no change in heart rate. There was an average decrease in mean arterial pressure of 1.8 mmHg (+46.2 mmHg). Within 24 hours of receiving methylene blue, 15/24 patients (62.5%) were able to come off of at least one vasopressor and 3/24 (12.5%) were able to come off of two vasopressors. The 30 day mortality rate was 45.8% in patients that received methylene blue.
Conclusion: The results of this study demonstrate that methylene blue may be considered for pediatric patients with refractory shock. However, given that this study was retrospective, there are limitations due to the reliance on the documented data within the patient's chart. A larger prospective study is warranted to determine the efficacy and safety of methylene blue for refractory shock in pediatric patients.