Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 29 , ISSUE 2 ( February, 2025 ) > List of Articles

EDITORIAL

Blue Hopes, Red Flags: The Methylene Blue Dilemma in Sepsis Shock

Deepak Govil, Anant Vikram Pachisia

Keywords : Circulatory failure, Methylene blue, Septic shock, Vasoplegia, Vasopressin, Vasopressors

Citation Information : Govil D, Pachisia AV. Blue Hopes, Red Flags: The Methylene Blue Dilemma in Sepsis Shock. Indian J Crit Care Med 2025; 29 (2):95-97.

DOI: 10.5005/jp-journals-10071-24912

License: CC BY-NC 4.0

Published Online: 31-01-2025

Copyright Statement:  Copyright © 2025; The Author(s).


Abstract

PDF Share
  1. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016;315(8):801–810. DOI: 10.1001/jama.2016.0287.
  2. Kraut JA, Madias NE. Lactic acidosis. N Engl J Med 2014;371(24):2309–2319. DOI: 10.1056/NEJMra1309483.
  3. Guarino M, Perna B, Cesaro AE, Maritati M, Spampinato MD, Contini C, et al. 2023 Update on sepsis and septic shock in adult patients: Management in the emergency department. J Clin Med 2023;12(9):3188. DOI: 10.3390/jcm12093188.
  4. Dünser MW, Hasibeder WR. Sympathetic overstimulation during critical illness: Adverse effects of adrenergic stress. J Intensive Care Med 2009;24(5):293–316. DOI: 10.1177/0885066609340519.
  5. Peter C, Hongwan D, Küpfer A, Lauterburg BH. Pharmacokinetics and organ distribution of intravenous and oral methylene blue. Eur J Clin Pharmacol 2000;56(3):247–250. DOI: 10.1007/s002280000124.
  6. Mc Donagh EM, Bautista JM, Youngster I, Altman RB, Klein TE. PharmGKB summary: Methylene blue pathway. Pharmacogenet Genomics 2013;23(9):498–508. DOI: 10.1097/FPC.0b013e32836498f4.
  7. Faber P, Ronald A, Millar BW. Methylthioninium chloride: Pharmacology and clinical applications with special emphasis on nitric oxide mediated vasodilatory shock during cardiopulmonary bypass. Anaesthesia 2005;60(6):575–587. DOI: 10.1111/j.1365-2044.2005.04185.x.
  8. Hosseinian L, Weiner M, Levin MA, Fischer GW. Methylene blue: Magic bullet for vasoplegia? Anesth Analg 2016;122(1):194–201. DOI: 10.1213/ANE.0000000000001045.
  9. Jang DH, Nelson LS, Hoffman RS. Methylene blue for distributive shock: A potential new use of an old antidote. J Med Toxicol 2013;9(3):242–249. DOI: 10.1007/s13181-013-0298-7.
  10. Puntillo F, Giglio M, Pasqualucci A, Brienza N, Paladini A, Varrassi G. Vasopressor-sparing action of methylene blue in severe sepsis and shock: A narrative review. Adv Ther 2020;37(9):3692–3706. DOI: 10.1007/s12325-020-01422-x.
  11. Kirov MY, Evgenov OV, Evgenov NV, Egorina EM, Sovershaev MA, Sveinbjørnsson B, et al. Infusion of methylene blue in human septic shock: A pilot, randomized, controlled study. Crit Care Med 2001;29(10):1860–1867. DOI: 10.1097/00003246-200110000-00002.
  12. Memis D, Karamanlioglu B, Yuksel M, Gemlik I, Pamukcu Z. The influence of methylene blue infusion on cytokine levels during severe sepsis. Anaesth Intensive Care 2002;30(6):755–762. DOI: 10.1177/0310057X0203000606.
  13. Ibarra-Estrada M, Kattan E, Aguilera-González P, Sandoval-Plascencia L, Rico-Jauregui U, Gómez-Partida CA, et al. Early adjunctive methylene blue in patients with septic shock: A randomized controlled trial. Crit Care 2023;27(1):110. DOI: 10.1186/s13054-023-04397-7.
  14. Dubey D, Ray P, Imran A. Methylene blue as adjunctive therapy in septic shock: Correct drug diluent derives optimal efficacy. Crit Care 2023;27(1):337. DOI: 10.1186/s13054-023-04615-2.
  15. Fernando SM, Tran A, Soliman K, Flynn B, Oommen T, Wenzhe L, et al. Methylene blue in septic shock: A systematic review and meta-analysis. Crit Care Explor 2024;6(7):e1110. DOI: 10.1097/CCE.0000000000001110.
  16. Pruna A, Bonaccorso A, Belletti A, Turi S, Di Prima AL, D’amico F, et al. Methylene blue reduces mortality in critically ill and perioperative patients: A meta-analysis of randomized trials. J Cardiothorac Vasc Anesth 2024;38(1):268–274. DOI: 10.1053/j.jvca.2023.09.037.
  17. Shaker EH, Soliman AM, Bedewy AAE, Elrawas MM. Comparative study between high and low dose methylene blue infusion in septic cancer patients: A randomized, blinded, controlled study. BMC Anesthesiol 2025;25(1):15. DOI: 10.1186/s12871-024-02792-3.
  18. Kuri HR, Sharma A, Meshram T, Kothari N, Goyal S, Paliwal B, et al. Effects of early use of methylene blue and vasopressin on noradrenaline dose in septic shock: A randomized controlled trial. Indian J Crit Care Med 2025;29(2):108–112.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.