Methylene Blue in Septic Shock: A Systematic Review and Meta-Analysis.

Methylene Blue / therapeutic use Humans Shock, Septic / drug therapy Randomized Controlled Trials as Topic Length of Stay Critical Illness

Journal

Critical care explorations
ISSN: 2639-8028
Titre abrégé: Crit Care Explor
Pays: United States
ID NLM: 101746347

Informations de publication

Date de publication:
01 Jul 2024
Historique:
medline: 21 6 2024
pubmed: 21 6 2024
entrez: 21 6 2024
Statut: epublish

Résumé

Although clinicians may use methylene blue (MB) in refractory septic shock, the effect of MB on patient-important outcomes remains uncertain. We conducted a systematic review and meta-analysis to investigate the benefits and harms of MB administration in patients with septic shock. We searched six databases (including PubMed, Embase, and Medline) from inception to January 10, 2024. We included randomized clinical trials (RCTs) of critically ill adults comparing MB with placebo or usual care without MB administration. Two reviewers performed screening, full-text review, and data extraction. We pooled data using a random-effects model, assessed the risk of bias using the modified Cochrane tool, and used Grading of Recommendations Assessment, Development, and Evaluation to rate certainty of effect estimates. We included six RCTs (302 patients). Compared with placebo or no MB administration, MB may reduce short-term mortality (RR [risk ratio] 0.66 [95% CI, 0.47-0.94], low certainty) and hospital length of stay (mean difference [MD] -2.1 d [95% CI, -1.4 to -2.8], low certainty). MB may also reduce duration of vasopressors (MD -31.1 hr [95% CI, -16.5 to -45.6], low certainty), and increase mean arterial pressure at 6 hours (MD 10.2 mm Hg [95% CI, 6.1-14.2], low certainty) compared with no MB administration. The effect of MB on serum methemoglobin concentration was uncertain (MD 0.9% [95% CI, -0.2% to 2.0%], very low certainty). We did not find any differences in adverse events. Among critically ill adults with septic shock, based on low-certainty evidence, MB may reduce short-term mortality, duration of vasopressors, and hospital length of stay, with no evidence of increased adverse events. Rigorous randomized trials evaluating the efficacy of MB in septic shock are needed. Center for Open Science (https://osf.io/hpy4j).

Identifiants

DOI: 10.1097/CCE.0000000000001110 PMID: 38904978
pubmed: 38904978
doi: 10.1097/CCE.0000000000001110
pii: 02107256-202407000-00002
doi:

Substances chimiques

Methylene Blue T42P99266K

Types de publication

Journal Article Systematic Review Meta-Analysis

Langues

eng

Sous-ensembles de citation

IM

Pagination

e1110

Subventions

Organisme : Lakeridge Health Foundation

Informations de copyright

Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.

Déclaration de conflit d'intérêts

Dr. Seely holds patents related to multiorgan variability analysis and has shares in Therapeutic Monitoring Systems. Dr. Cook is supported by a Canada Research Chair in Critical Care Knowledge Translation. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Références

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Auteurs

Shannon M Fernando (SM)

Department of Critical Care, Lakeridge Health Corporation, Oshawa, ON, Canada.
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
ORCID: 0000-0003-4549-4289

Alexandre Tran (A)

Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
Department of Surgery, University of Ottawa, Ottawa, ON, Canada.

Karim Soliman (K)

Department of Critical Care, Lakeridge Health Corporation, Oshawa, ON, Canada.
Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada.

Barbara Flynn (B)

Department of Critical Care, Lakeridge Health Corporation, Oshawa, ON, Canada.

Thomas Oommen (T)

Department of Critical Care, Lakeridge Health Corporation, Oshawa, ON, Canada.

Li Wenzhe (L)

Department of Critical Care Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.

Neill K J Adhikari (NKJ)

Department of Critical Care, Lakeridge Health Corporation, Oshawa, ON, Canada.
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
Department of Surgery, University of Ottawa, Ottawa, ON, Canada.
Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada.
Department of Critical Care Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada.
Centre de Recherche du CHU de Sherbrooke, Sherbrooke, QC, Canada.

Salmaan Kanji (S)

Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.

Andrew J E Seely (AJE)

Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
Department of Surgery, University of Ottawa, Ottawa, ON, Canada.

Alison E Fox-Robichaud (AE)

Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.

Randy S Wax (RS)

Department of Critical Care, Lakeridge Health Corporation, Oshawa, ON, Canada.
Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada.

Deborah J Cook (DJ)

Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.

François Lamontagne (F)

Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada.
Centre de Recherche du CHU de Sherbrooke, Sherbrooke, QC, Canada.

Bram Rochwerg (B)

Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.

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questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Choc › Syndrome de réponse inflammatoire généralisée › Choc septique › Methylene Blue in Septic Shock: A Systematic...
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