A study published in Crit_Care finds that early adjunctive methylene blue administration reduces vasopressor duration, cumulative fluid balance, and ICU and hospital length of stay among patients with septic shock.
]. We designed this RCT to assess if early adjunctive MB administration could reduce the time to vasopressor discontinuation in patients with septic shock, as compared to placebo.We conducted an investigator-initiated, parallel, double blinded, randomized controlled trial at an academic reference center in Mexico, in a medical-surgical intensive care unit .
Patients assigned to MB group received an intravenous infusion of 100 mg of MB in 500 ml of 0.9% sodium chloride solution over 6 h once daily for a total of 3 doses. Patients assigned to control group received the same dose of 500 ml of 0.9% sodium chloride without MB. In order to avoid visual identification of the infusion, all infusion bags and polyvinylchloride lines were prepared at central pharmacy with opaque envelopes.
In patients of both groups, adjunctive vasopressin was initiated at a dose of 0.03 IU/min if norepinephrine dose reached ≥ 0.25 mcg/kg/min; evaluation of volume responsiveness was repeated at least 3 times each day as long as vasopressors were needed. Hydrocortisone at 200 mg/day dose by continuous infusion is also a standard in our unit, and it is withheld within 6-h after discontinuation of all vasopressors without taper [].
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