Anest. intenziv. Med. 2021;32(4-5):211-216 | DOI: 10.36290/aim.2021.045

Methylene blue administration in refractory distributive shockReview Article

Pořízka M.1, Říha H.1, 2, Balík M.1
1 Klinika anesteziologie, resuscitace a intenzivní medicíny, 1. lékařská fakulta Univerzity Karlovy a Všeobecná fakultní nemocnice, Praha
2 Klinika anesteziologie a resuscitace, Kardiocentrum, Institut klinické a experimentální medicíny, Praha

Refractory distributive shock is associated with excessive mortality in critically ill patients. Non-adrenergic vasopressors, including methylene blue, are often considered as an adjuvant therapy to the usual, catecholamine-based vasopressor treatment. In this narrative review we summarize the current scientific evidence on the use of methylene blue in the treatment of refractory distributive shock in different clinical situations.

Keywords: methylene blue, distributive shock, refractory shock, vasoplegia, vascular hyporesponsiveness.

Received: June 25, 2021; Revised: August 20, 2021; Accepted: September 14, 2021; Published: December 2, 2021  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Pořízka M, Říha H, Balík M. Methylene blue administration in refractory distributive shock. Anest. intenziv. Med. 2021;32(4-5):211-216. doi: 10.36290/aim.2021.045.
Download citation

References

  1. Bassi E, Park M, Azevedo LC. Therapeutic strategies for high‑dose vasopressor‑dependent shock. Crit Care Res Pract. 2013; 2013: 654708. doi: 10.1155/2013/654708. Go to original source... Go to PubMed...
  2. De Backer D, Biston P, Devriendt J, Madl C, Chochrad D, Aldecoa C, et al.; SOAP II Investigators. Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med. 2010; 362(9): 779-789. doi: 10.1056/NEJMoa0907118. Go to original source... Go to PubMed...
  3. Jenkins CR, Gomersall CD, Leung P, Joynt GM. Outcome of patients receiving high dose vasopressor therapy: a retrospective cohort study. Anaesth Intensive Care. 2009; 37(2): 286-289. Go to original source... Go to PubMed...
  4. Levy B, Collin S, Sennoun N, Ducrocq N, Kimmoun A, Asfar P, et al. Vascular hyporesponsiveness to vasopressors in septic shock: from bench to bedside. Intensive Care Med. 2010 Dec; 36(12): 2019-2029. doi: 10.1007/s00134-010-2045-8. Go to original source... Go to PubMed...
  5. Russell JA, Gordon AC, Williams MD, Boyd JH, Walley KR, Kissoon N. Vasopressor Therapy in the Intensive Care Unit. Semin Respir Crit Care Med. 2021 Feb; 42(1): 59-77. doi: 10.1055/s-0040-1710320. Go to original source... Go to PubMed...
  6. 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. Go to original source... Go to PubMed...
  7. Forstermann U, Sessa W. Nitric oxide synthases: regulation and function. Eur Heart J. 2012; 33(829-837): 837a-837d. Go to original source... Go to PubMed...
  8. Elbers P, Ince C. Mechanisms of critical illness - classifying microcirculatory flow abnormalities in distributive shock. Crit Care. 2006; 10(4): 221. Go to original source... Go to PubMed...
  9. Cauwels A. Nitric oxide in shock. Kidney Int. 2007; 72: 557-565. Go to original source... Go to PubMed...
  10. Lambden S, Creagh‑Brown BC, Hunt J, Summers C, Forni LG. Definitions and Pathophysiology of vasoplegic shock. Crit Care. 2018; 22(1): 174. Go to original source... Go to PubMed...
  11. MacNaul KL, Hutchinson NI. Differential expression of iNOS and cNOS mRNA in human vascular smooth muscle cells and endothelial cells under normal and inflammatory conditions. Biochem Biophys Res Commun. 1993; 196(3): 1330-1334. Go to original source... Go to PubMed...
  12. Losada AP, Bermúdez R, Faílde LD, Quiroga MI. Quantitative and qualitative evaluation of iNOS expression in turbot (Psetta maxima) infected with Enteromyxum scophthalmi. Fish Shellfish Immunol. 2012; 32(2): 243-248. doi: 10.1016/j.fsi.2011. 11. 007. Go to original source...
  13. Juřica J. Methylenová modř. Remedia. 2018; 28: 264-271.
  14. Lenglet S, Mach F, Montecucco F. Methylene blue: potential use of an antique molecule in vasoplegic syndrome during cardiac surgery. Expert Rev Cardiovasc Ther. 2011 Dec; 9(12): 1519-1525. doi: 10.1586/erc.11.160. Go to original source... Go to PubMed...
  15. Clifton J, Leikin JB. Methylene blue. Am J Ther. 2003; 10(4): 289-291. Go to original source... Go to PubMed...
  16. Tchen S, Sullivan JB. Clinical utility of midodrine and methylene blue as catecholamine‑sparing agents in intensive care unit patients with shock. J Crit Care. 2020 Jun; 57: 148-156. doi: 10.1016/j.jcrc.2020. 02. 011. Go to original source...
  17. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med. 2017 Mar; 43(3): 304-377. doi: 10.1007/s00134-017-4683-6. Go to original source... Go to PubMed...
  18. Peng Q, Brown SB, Moan J, Nesland JM, Wainwright M, Griffiths J, et al. Biodistribution of a methylene blue derivative in tumor and normal tissues of rats. J Photochem Photobiol B. 1993 Sep; 20(1): 63-71. doi: 10.1016/1011-1344(93)80132-s. Go to original source... Go to PubMed...
  19. Watson D, Grover R, Anzueto A, Lorente J, Smithies M, Bellomo R, et al. Glaxo Wellcome International Septic Shock Study Group. Cardiovascular effects of the nitric oxide synthase inhibitor NG‑methyl‑L-arginine hydrochloride (546C88) in patients with septic shock: results of a randomized, double‑blind, placebo‑controlled multicenter study (study no. 144-002). Crit Care Med. 2004 Jan; 32(1): 13-20. doi: 10.1097/01.CCM.0000104209.07273.FC. Go to original source... Go to PubMed...
  20. Gachot B, Bedos JP, Veber B, Wolff M, Regnier B. Short‑term effects of methylene blue on hemodynamics and gas exchange in humans with septic shock. Intensive Care Med. 1995; 21(12): 1027-1031. https://doi.org/10.1007/bf01700666. Go to original source... Go to PubMed...
  21. Park BK, Shim TS, Lim CM, Lee SD, Kim WS, Kim DS, et al. The effects of methylene blue on hemodynamic parameters and cytokine levels in refractory septic shock. Korean J Intern Med. 2005; 20(2): 123-128. doi: 10.3904/kjim.2005. 20. 2.123. Go to original source... Go to PubMed...
  22. 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. Go to original source... Go to PubMed...
  23. 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 Oct; 29(10): 1860-1867. doi: 10.1097/00003246-200110000-00002. PMID: 11588440. Go to original source... Go to PubMed...
  24. Ramamoorthy S, Patel S, Bradburn E, Kadry Z, Uemura T, Janicki P, et al. Use of methylene blue for treatment of severe sepsis in an immunosuppressed patient after liver transplantation. Case Rep Transplant. 2013; 2013: 203791. doi: 10.1155/2013/203791. Go to original source... Go to PubMed...
  25. Denny JT, Burr AT, Balzer F, Tse JT, Denny JE, Chyu D. Methylene blue treatment for cytokine release syndrome‑associated vasoplegia following a renal transplant with rATG infusion: A case report and literature review. Exp Ther Med. 2015 May; 9(5): 1915-1920. doi: 10.3892/etm.2015.2349. Go to original source... Go to PubMed...
  26. Heemskerk S, van Haren FM, Foudraine NA, Peters WH, van der Hoeven JG, Russel FG, et al. Short‑term beneficial effects of methylene blue on kidney damage in septic shock patients. Intensive Care Med. 2008 Feb; 34(2): 350-354. doi: 10.1007/s00134-007-0867-9. Go to original source... Go to PubMed...
  27. Beckman JS, Koppenol WH. Nitric oxide, superoxide, and peroxynitrite: the good, the bad, and ugly. Am J Physiol. 1996; 271(5 Pt 1): C1424-C1437. doi: 10.1152/ajpcell.1996.271. 5. C1424. Go to original source... Go to PubMed...
  28. Blackwell TS, Christman JW. Sepsis and cytokines: current status. Br J Anesth. 1996; 77: 110-117. Go to original source... Go to PubMed...
  29. Harbrech BG, Wang SC, Simmons RL, Billiar TR. Cyclic GMP and guanylate cyclase mediate lipopolysaccharide‑induced Kupffer cell tumor necrosis factor‑α sysnthesis. J Leukoc Biol. 1995; 57: 297-302. Go to original source... Go to PubMed...
  30. Lieberman P. The use of antihistamines in the prevention and treatment of anaphylaxis and anaphylactoid reactions. J Allergy Clin Immunol. 1990; 86(4 Pt 2): 684-686. doi: 10.1016/s0091-6749(05)80241-6. Go to original source... Go to PubMed...
  31. Enjeti S, Bleecker ER, Smith PL, Rabson J, Permutt S, Traystman RJ. Hemodynamic mechanisms in anaphylaxis. Circ Shock. 1983; 11(4): 297-309.
  32. Tanimoto A, Wang KY, Murata Y, Kimura S, Nomaguchi M, Nakata S, et al. Histamine upregulates the expression of inducible nitric oxide synthase in human intimal smooth muscle cells via histamine H1 receptor and NF‑kappaB signaling pathway. Arterioscler Thromb Vasc Biol. 2007; 27(7): 1556-1561. doi: 10.1161/ATVBAHA.106.139089. Go to original source... Go to PubMed...
  33. Li H, Burkhardt C, Heinrich UR, Brausch I, Xia N, Förstermann U. Histamine upregulates gene expression of endothelial nitric oxide synthase in human vascular endothelial cells. Circulation. 2003; 107(18): 2348-2354. doi: 10.1161/01.CIR.0000066697.19571.AF. Go to original source... Go to PubMed...
  34. Oliveira Neto AM, Duarte NM, Vicente WV, Viaro F, Evora PR. Methylene blue: an effective treatment for contrast medium‑induced anaphylaxis. Med Sci Monit. 2003 Nov; 9(11): CS102-6. Go to PubMed...
  35. Del Duca D, Sheth SS, Clarke AE, Lachapelle KJ, Ergina PL. Use of methylene blue for catecholamine‑refractory vasoplegia from protamine and aprotinin. Ann Thorac Surg. 2009 Feb; 87(2): 640-642. doi: 10.1016/j.athoracsur.2008. 07. 017. Go to original source...
  36. Rodrigues JM, Pazin Filho A, Rodrigues AJ, Vicente WV, Evora PR. Methylene blue for clinical anaphylaxis treatment: a case report. Sao Paulo Med J. 2007 Jan 4; 125(1): 60-62. doi: 10.1590/s1516-31802007000100012. Go to original source... Go to PubMed...
  37. Laes JR, Williams DM, Cole JB. Improvement in Hemodynamics After Methylene Blue Administration in Drug‑Induced Vasodilatory Shock: A Case Report. J Med Toxicol. 2015 Dec; 11(4): 460-463. doi: 10.1007/s13181-015-0500-1. Go to original source... Go to PubMed...
  38. Jang DH, Nelson LS, Hoffman RS. Methylene blue in the treatment of refractory shock from an amlodipine overdose. Ann EmergMed. 2011; 58: 565-567. Go to original source... Go to PubMed...
  39. Lenasi H, Kohlstedt K, Fichtlscherer B, Mülsch A, Busse R, Fleming I. Amlodipine activates the endothelial nitric oxide synthase by altering phosphorylation on Ser1177 and Thr495. Cardiovasc Res. 2003; 59: 844-853. Go to original source... Go to PubMed...
  40. Hall RI, Smith MS, Rocker G. The systemic inflammatory response to cardiopulmonary bypass: Pathophysiological, therapeutic, and pharmacological considerations. Anesth Analg. 1997; 85: 766-782. Go to original source... Go to PubMed...
  41. Wan S, LeClerc JL, Vincent JL. Inflammatory response to cardiopulmonary bypass: Mechanisms involved and possible therapeutic strategies. Chest. 1997; 112: 676-692. Go to original source... Go to PubMed...
  42. Kerbaul F, Guidon C, Lejeune PJ, Mollo M, Mesana T, Gouin F. Hyperprocalcitonemia is related to noninfectious postoperative severe systemic inflammatory response syndrome associated with cardiovascular dysfunction after coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth. 2002; 16: 47-53. Go to original source... Go to PubMed...
  43. Gomes WJ, Carvalho AC, Palma JH, Teles CA, Branco JN, Silas MG, et al. Vasoplegic syndrome after open heart surgery. J Cardiovasc Surg (Torino). 1998; 39: 619-623. Go to PubMed...
  44. Levin MA, Lin HM, Castillo JG, Adams DH, Reich DL, Fischer GW. Early on‑cardiopulmonary bypass hypotension and other factors associated with vasoplegic syndrome. Circulation. 2009; 120: 1664-1671. Go to original source... Go to PubMed...
  45. Mets B, Michler RE, Delphin ED, Oz MC, Landry DW. Refractory vasodilation after cardiopulmonary bypass for heart transplantation in recipients on combined amiodarone and angiotensin‑converting enzyme inhibitor therapy: a role for vasopressin administration. J Cardiothorac Vasc Anesth. 1998; 12: 326-329. Go to original source... Go to PubMed...
  46. Raja SG, Dreyfus GD. Vasoplegic syndrome after off‑pump coronary artery bypass surgery: an unusual complication. Tex Heart Inst J. 2004; 31: 421-424.
  47. Weis F, Kilger E, Beiras‑Fernandez A, Nassau K, Reuter D, Goetz A. Association between vasopressor dependence and early outcome in patients after cardiac surgery. Anaesthesia. 2006; 61: 938-942. Go to original source... Go to PubMed...
  48. Sundaram V, Fang JC. Gastrointestinal and liver issues in heart failure. Circulation. 2016; 133: 1696-1703. Go to original source... Go to PubMed...
  49. Yiu P, Robin J, Pattison CW. Reversal of refractory hypotension with single‑dose methylene blue after coronary artery bypass surgery. J Thorac Cardiovasc Surg. 1999; 118: 195-196. Go to original source... Go to PubMed...
  50. Říha H, Říhová L, Pinďák M, Březina A, Pirk J. Metylénova modř v léčbě vazoplegického syndromu po kardiochirurgické operaci. Čas Lék Česk. 2006; 145: 322-324. Go to PubMed...
  51. Levin RL, Degrange MA, Bruno GF, Del Mazo CD, Taborda DJ, Griotti JJ, et al. Methylene blue reduces mortality and morbidity in vasoplegic patients after cardiac surgery. Ann Thorac Surg. 2004; 77: 496-499. Go to original source... Go to PubMed...
  52. Maslow AD, Stearns G, Butala P, Schwartz CS, Gough J, Singh AK. The hemodynamic effects of methylene blue when administered at the onset of cardiopulmonary bypass. Anesth Analg. 2006; 103: 2-8. Go to original source... Go to PubMed...
  53. Ozal E, Kuralay E, Yildirim V, Kilic S, Bolcal C, Kücükarslan N, et al. Preoperative methylene blue administration in patients at high risk for vasoplegic syndrome during cardiac surgery. Ann Thorac Surg. 2005; 79: 1615-1619. Go to original source... Go to PubMed...
  54. Kofler O, Simbeck M, Pichlmaier M, Zwissler B, Von Dossow V. Treatment of vasoplegic syndrome during cardiopulmonary bypass with methylene blue restores hemodynamic function and affects the overall survival: A 10-years retrospective large‑volume cohort study abstract. Eur J Anaesthesiol. 2018; 35: 188. Go to original source...
  55. Weiner MM, Lin HM, Danforth D, Rao S, Hosseinian L, Fischer GW. Methylene blue is associated with poor outcomes in vasoplegic shock. J Cardiothorac Vasc Anesth. 2013; 27: 1233-1238. Go to original source... Go to PubMed...
  56. Metz S, Horrow JC, Goel IP, Kuretu ML, Bellwoar C. Methylene blue does not neutralize heparin after cardiopulmonary bypass. J Cardiothorac Vasc Anesth. 1996; 10: 474-476. Go to original source... Go to PubMed...
  57. de Waal EEC, van Zaane B, van der Schoot MM, Huisman A, Ramjankhan F, van Klei WA, et al. Vasoplegia after implantation of a continuous flow left ventricular assist device: Incidence, outcomes and predictors. BMC Anesthesiol. 2018; 18: 185. Go to original source... Go to PubMed...
  58. Ortoleva J, Roberts RJ, Devine LT, French A, Kawabori M, Chen F, et al. Methylene blue for vasoplegia during extracorporeal membrane oxygenation support. J Cardiothorac Vasc Anesth. 2020 Dec 29:S1053-0770(20)31389-6. doi: 10.1053/j.jvca.2020. 12. 042. Go to original source...
  59. Říha H, Augoustides JG. Pro: Methylene blue as a rescue therapy for vasoplegia after cardiac surgery. J Cardiothorac Vasc Anesth. 2011; 25: 736-738. Go to original source... Go to PubMed...
  60. Andritsos MJ. Con: methylene blue should not be used routinely for vasoplegia perioperatively. J Cardiothorac Vasc Anesth. 2011; 25: 739-743. Go to original source... Go to PubMed...
  61. Pořízka M, Kopecký P, Dvořáková H, Kunstyr J, Lips M, Michalek P, et al. Methylene blue administration in patients with refractory distributive shock - a retrospective study. Sci Rep. 2020; 10: 1828. Go to original source... Go to PubMed...
  62. Evora PR, Ribeiro PJ, Vicente WV, Reis CL, Rodrigues AJ, Menardi AC, et al. Methylene blue for vasoplegic syndrome treatment in heart surgery: fifteen years of questions, answers, doubts and certainties. Rev Bras Cir Cardiovasc. 2009; 24(3): 279-288. doi: 10.1590/s0102-76382009000400005 Go to original source... Go to PubMed...
  63. Héritier Barras AC,Walder B, SeeckM. Serotonin syndrome following methylene blue infusion: a rare complication of antidepressant therapy. J Neurol Neurosurg Psychiatry. 2010 Dec; 81(12): 1412-1413. doi: 10.1136/jnnp.2009.172221. Go to original source... Go to PubMed...
  64. Martino EA, Winterton D, Nardelli P, Pasin L, Calabrò MG, Bove T, et al. The Blue Coma: The Role of Methylene Blue in Unexplained Coma After Cardiac Surgery. J Cardiothorac Vasc Anesth. 2016; 30(2): 423-427. doi: 10.1053/j.jvca.2015. 09. 011. Go to original source... Go to PubMed...
  65. Goluboff N, Wheaton R. Methylene blue‑induced cyanosis and acute hemolytic anemia complicating the treatment of methemoglobinemia. J Pediatr. 1961; 58: 86-89. Go to original source... Go to PubMed...
  66. Weingartner R, Oliveira E, Oliveira ES, Sant'Anna UL, Oliveira RP, Azambuja LA, et al. Blockade of the action of nitric oxide in human septic shock increases systemic vascular resistance and has detrimental effects on pulmonary function after a short infusion of methylene blue. Braz J Med Biol Res. 1999; 32(12): 1505-1513. Go to original source... Go to PubMed...
  67. 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 Sep; 37(9): 3692-3706. doi: 10.1007/s12325-020-01422-x. Go to original source... Go to PubMed...
  68. Kessler MR, Eide T, Humayun B, Poppers PJ. Spurious pulse oximeter desaturation with methylene blue injection. Anesthesiology. 1986; 65(4): 435-436. Go to original source... Go to PubMed...
  69. Busse LW, Barker N, Petersen C. Vasoplegic syndrome following cardiothoracic surgery - review of pathophysiology and update of treatment options. Crit Care. 2020; 24(1): 36. Go to original source... Go to PubMed...




Anesteziologie a intenzivní medicína

Madam, Sir,
please be aware that the website on which you intend to enter, not the general public because it contains technical information about medicines, including advertisements relating to medicinal products. This information and communication professionals are solely under §2 of the Act n.40/1995 Coll. Is active persons authorized to prescribe or supply (hereinafter expert).
Take note that if you are not an expert, you run the risk of danger to their health or the health of other persons, if you the obtained information improperly understood or interpreted, and especially advertising which may be part of this site, or whether you used it for self-diagnosis or medical treatment, whether in relation to each other in person or in relation to others.

I declare:

  1. that I have met the above instruction
  2. I'm an expert within the meaning of the Act n.40/1995 Coll. the regulation of advertising, as amended, and I am aware of the risks that would be a person other than the expert input to these sites exhibited


No

Yes

If your statement is not true, please be aware
that brings the risk of danger to their health or the health of others.