Effect of Methylene Blue on Vasopressor Requirements in Patients With Septic Shock

Introduction: Methylene blue has shown promising effects in hemodynamic improvement for patients with septic shock requiring vasopressors. The objective of this study was to assess change in vasopressor requirements in patients receiving methylene blue in septic shock.


Methods: This single center retrospective cohort study included patients with septic shock who were ≥ 18 years old and admitted to the emergency department or intensive care unit (ICU). All patients received methylene blue via slow IV push over 5 minutes. The primary outcome assessed the change in vasopressors 12 hours after methylene blue administration. Secondary outcomes included change in vasopressor requirements 6 and 24 hours after methylene blue administration, hospital and ICU length of stay, total number of methylene blue doses and reported adverse effects. Descriptive statistics were analyzed for all outcomes assessed.


Results: Of 38 patients who met inclusion criteria, 36 patients were included in this descriptive study. The study population had a mean age of 58 (SD ± 15) years, required a median of 65.1 (IQR 50.1 - 75.6) mcg/min of vasopressors prior to methylene blue administration reported in norepinephrine equivalents (NEE) and received a median methylene blue dose of 1.54 (SD ± 0.56) mg/kg. For the primary outcome, a decrease in vasopressors was observed 12 hours after methylene blue administration by a median of 17.5 mcg/min of NEE. At the 6 hour time point after methylene blue administration, a median decrease in vasopressor requirements of 2.5 mcg/min of NEE was observed. Vasopressor requirements at the 24 hour time point after methylene blue administration were decreased by a median of 14 mcg/min of NEE. For overall patient outcomes, there was an incidence of all-cause mortality in 28 patients (78 %), median ICU length of stay of 4 (IQR 2 – 12) days and median hospital length of stay of 5 (IQR 2 – 9) days. No adverse effects were reported.


Conclusions: Patients that received methylene blue had a reduction in vasopressor requirements at all time points assessed with no additional adverse effects identified.