Racha Kabbani, PharmD
Critical Care Pharmacist Resident
UW Medicine
Seattle, Washington
Disclosure information not submitted.
Jon Dorfman, MD
Critical Care Physician
UMass Memorial Medical Center, United States
Disclosure information not submitted.
Michael Ha, PharmD, BCPS, BCCCP
Critical Care Pharmacist
UMass Memorial Medical Center, United States
Disclosure information not submitted.
Title: Methylene Blue Utilization for Septic Shock
Introduction: Methylene blue (MB) is a chemical dye that selectively inhibits inducible nitric oxide synthase and provides a unique mechanism to increase organ perfusion when vasopressor therapy is unsuccessful. Limited data suggests MB therapy as beneficial when utilized for refractory hypotension in septic shock.
Methods: This is a single center, retrospective case-control study evaluating outcomes for MB therapy utilization in septic shock (defined as requiring > 1 vasopressor for mean arterial blood pressure (MAP) < 65 mmHg). Patients who received MB therapy were propensity matched to case-controls based on age, gender, sequential organ functional assessment (SOFA), and acute physiology and chronic health evaluation IV score. Prisoners and pregnant patients were excluded. The primary outcomes were intensive care unit (ICU) and hospital mortality. Secondary outcomes included dose and duration of vasopressors, change in MAP at 1 hour, and change in SOFA score at 24-hours after MB administration/peak vasopressor requirements.
Results: 33 patients who received MB therapy for septic shock were propensity matched to 33 case-controls. The mean age was 62 years old, and a majority were male (61%). More case-controls had an unknown source of infection compared to patients who received MB therapy (p=0.02). Patients who received MB therapy had significantly more surgical ICU (73% vs. 27%, p=0.002, respectively) admissions as compared to medical admissions. Patients who received MB therapy had almost a two-fold significant increase in ICU mortality (84% vs. 48%, p=0.001) and hospitality mortality (88% vs 48%, p=0.002). For secondary outcomes, no significant difference was seen for dose and duration of vasopressors (p=0.06 and p=0.09, respectively), change in MAP at 1 hour (p=0.23), and change in SOFA score at 24-hours after MB administration/peak vasopressor requirements (p=0.42).
Conclusions: Although a retrospective study, we found MB therapy to be associated with a significant increase in mortality, no reduction of vasopressor requirements, no improvement in MAP at 1 hour, or improvement in SOFA score. Thus, we conclude that MB could have been harmful, ineffective, or administered too late at our institution.