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VOLUME 24 , ISSUE 3 ( March, 2020 ) > List of Articles
Abhishek Jaiswal, Elizabeth Silver
Keywords : Extra corporeal membrane oxygenation, Methylene blue, Refractory shock, Sepsis induced
Citation Information : Jaiswal A, Silver E. Extended Continuous Infusion of Methylene Blue for Refractory Septic Shock. Indian J Crit Care Med 2020; 24 (3):206-207.
License: CC BY-NC 4.0
Published Online: 01-03-2020
Copyright Statement: Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.
Objective: Highlight the utility of methylene blue (MTB) infusion for extended period for refractory vasoplegia. Introduction: Hypotension refractory to vasopressor therapy in sepsis is associated with high mortality and limited therapeutic options. Dysregulated nitric oxide (NO) pathway seems to be a major driver, and, therefore, MTB, which inhibits inducible NO synthase activity and decreases cyclic guanosine monophosphate (GMP) accumulation by directly competing with NO by binding to soluble guanylyl cyclase, has been explored. Case description: We describe a successful reversal of refractory septic shock with prolonged MTB infusion in a patient supported on multiple vasopressors at the highest clinical doses as well as venovenous extracorporeal membrane oxygenation (VV-ECMO). Conclusion and clinical significance: Current report suggests a potential role of MTB infusion in refractory vasoplegia even in advanced vasoplegic shock.
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