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VOLUME 25 , ISSUE 8 ( August, 2021 ) > List of Articles


Intravenous Methylene Blue as a Rescue Therapy in the Management of Refractory Hypoxia in COVID-19 ARDS Patients: A Case Series

Srinath Marreddy, Snehal D Gokhale, Pradip Funde, Prasad V Akole, Pradip Dalvi, Prasanna Marudwar, Shradha Gugale, Manasi S Shahane, Sarang N Kshirsagar

Keywords : Acute respiratory distress syndrome, Coronavirus disease 2019, Methylene blue, Rescue therapy

Citation Information : Marreddy S, Gokhale SD, Funde P, Akole PV, Dalvi P, Marudwar P, Gugale S, Shahane MS, Kshirsagar SN. Intravenous Methylene Blue as a Rescue Therapy in the Management of Refractory Hypoxia in COVID-19 ARDS Patients: A Case Series. Indian J Crit Care Med 2021; 25 (8):934-938.

DOI: 10.5005/jp-journals-10071-23905

License: CC BY-NC 4.0

Published Online: 12-08-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Objectives: To describe the clinical outcomes of hypoxic coronavirus disease 2019 (COVID-19) patients treated with intravenous methylene blue (MB) in a tertiary care hospital. Materials and methods: We conducted a case series of 50 patients with hypoxic COVID-19 treated with intravenous MB admitted to our hospital between June 01 and September 10, 2020. Intravenous MB was administered as rescue therapy in dosage of 1 mg/kg body weight, with a maximum of five doses, to patients with high oxygen requirements (SpO2/FiO2 <200) apart from the standard of care after obtaining G6PD levels. Data were abstracted from multiple electronic data sources or patient charts to provide information on patient characteristics, clinical and laboratory variables and outcomes. Results: The median age of the patients was 53.3 (range 25–74 years) and most patients (74%) were men. About 68% of patients had pre-existing comorbidity. Median SpO2/FiO2 ratio progressively improved from 132.5 (predose) to 284 before the terminal event (death or discharge), ventilator-free days, and decrease in the proinflammatory biochemical parameter was significantly higher after the second dose of MB. A total of six patients out of 50 required invasive mechanical ventilation (IMV). Thirty patients were discharged with a recovery rate of 60%, while 20 patients succumbed to the illness. There was no major side effect or adverse event reported in any of the patients. Conclusion: MB due to its polypharmacological action against SARS-CoV-2, an inexpensive and widely available drug with minimal side effects, has a significant potential in the treatment of COVID-19.

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