Background:

Generalized vasodilation with nonresponding hypotension is present in half of death cases due to septicemia. Methylene blue could be used as a valuable adjuvant in the treatment of refractory hypotension. The aim of this study was to determine the effectiveness of methylene blue as a contributory treatment in patients with septic shock.

Material and methods:

A controlled, randomized, double-blinded, clinical trial was performed. Sixty patients were divided in two groups. Group A received a single dose of methylene blue calculated 2 mg/kg per body weight diluted in 100 cm3 of 5% dextrose infused in 60 minutes, and group C (control) received 100 cm3 of 5% dextrose infused in 60 minutes. Basal measurements of the study variables were taken (MBP, lactate, base deficit, central venous saturation and CO2 delta) prior to the administration of methylene blue and every hour afterwards, until MBP > 65 mmHg without vasopressor or 72 hours had passed after shock began. Data about total noradrenaline dose in mg, length of stay, length of mechanical ventilation and mortality was recorded.

Results:

MBP increased progressively the first six hours after the methylene blue infusion in group A, 22%, and in group C, 9.2% (p: < 0.05), steadily during the 72-hour follow-up. The noradrenaline dose decreased in the first six hours, in group A 86%, in group C, 56% (p: < 0.05). Lactate clearance in the first six hours was 62% in group A; in contrast, group C had a 33% clearance (p: < 0.05). Mortality at ICU discharge on group A was 20.0% and on group C was 36.6% (p: < 0.05), without variation on 21 days.

Conclusion:

Methylene blue is effective as an adjuvant in the treatment of septic shock.

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