Table 1.
Case reports of the use of methylene blue to treat refractory shock in patients less than 25 years old. MB: methylene blue, B: bolus dose, I: infusion, BP; blood pressure, MB; methylene blue, CHD; congenital heart disease, CO; cardiac output, SVR; systemic vascular resistance, VIS; vasoactive-inotropic score, MAP; mean arterial blood pressure, CI; cardiac index, SvcO2; central venous oxygen saturation, CPB; cardiopulmonary bypass, N/s: not specified. (*) Indicates conference abstracts
| Study, year, country |
Patient age, sex and diagnosis |
MB dose | VIS pre MB | VIS post MB |
Major findings |
|---|---|---|---|---|---|
| Chan et al, 2018, Australia(28) | 15 y/o male with shock due to intentional overdose | B: 1.5 mg/kg I: 1.5 mg/kg/hr for 12 hr, then 1 mg/kg/hr for 12 hr |
1200 with metaraminol | 402 by 6 hr | BP increased from 65/40 to 120/45 and CO was 8L/min and SVR 300 dyn×sec×cm−5 after MB. MB levels were followed and t1/2 was calculated to be 37.6 hr |
| Shen, 2018, United States (29) | 17 y/o male with shock due to trauma | B:100 mg I: 500mg over 6 hr |
n/s | 0 by 6 hr | Clinical status improved, and epinephrine and norepinephrine were weaned off 6 hr after MB |
| Volpon et. al. 2018, Brazil(30) | 4 y/o male with shock due to trauma | B: 0.5 mg/kg | 80 | 40 by 2 hr | BP increased from 90/40 to 100s/50s and norepinephrine, epinephrine and dopamine weaned 2 hr after MB |
| *Cebula and Musfeldt, 2016, United States(31) | 24 y/o male with shock due to intentional overdose | B: 1.5 mg/kg I: 1 mg/kg/hr |
N/s | 0 by 2 hr | MAPs improved from 40s to 60s and vasopressin, epinephrine, and phenylephrine weaned off 2 hr after MB |
| Lee 2016, United States(32) | 7 y/o female with shock due to heart failure | B: 1.5 mg/kg | 25 | 3 by 30 min | BP increased, and vasopressin and epinephrine were weaned 30 min after MB |
| Hershman et al. 2015, Israel(33) | 19 y/o female with shock after kidney transplant | B: 1mg/kg | 92 with phenylephrine | 0 by 8 hr | BP normalized to 120/60, HR lowered to 100 bpm and norepinephrine, dopamine and phenylephrine weaned within 8 hr after MB |
| Rutledge et. al. 2015, United States(34) | 22 m/o female with shock due to CHD and sepsis | B: 1 mg/kg I: 0.25 mg/kg/hr |
520 | 0 by 14 h | Systolic BP rose 40%, diastolic BP rose 46% and dopamine, norepinephrine and vasopressin were weaned 14 h after MB |
| *Cheng et al.2012, United States(35) | 18 y/o female with shock after liver transplant | B: 2 mg/kg | 10 | 4 by n/s | BP increased from 72/25 to 115/55 and dopamine and epinephrine were weaned immediately after MB |
| *Ali and Lindley, 2012, United Kingdom(36) | 23 y/o female with shock due to sepsis | B: 1 mg/kg I: 0.25 mg/kg/hr |
N/s | N/s | HR, BP and CI increased, SVR increased from 200 to 800 dyn×sec×cm−5 and epinephrine and vasopressin weaned after MB. |
| Banille et al. 2011, Argentina(37) | 15 m/o male with shock due to CHD | B: 1 mg/kg/ for 2 doses | 24 | N/s | HR improved, BP and SvcO2 increased and dopamine and norepinephrine were weaned 11 hr after MB |
| Lopez, 2011, Spain(38) | Newborn with shock due to sepsis | B: 1 mg/kg | 100 with hydrocortisone | 50 by 6hr | MAP increased from 28 to 35 mmHg and dopamine, dobutamine and norepinephrine weaned 6 hr after MB |
| Bhalla et al, 2011, United States(39) | 5 y/o female with cardiogenic shock after CPB | B: 1 mg/kg | 840 | 0 by 12 hr | MAP increased from 30 to 60 mmHg and epinephrine, norepinephrine, and vasopressin weaned 12 h after MB |
| Jang et al. 2011, United States (40) | 25 y/o female with shock due to intentional overdose | B: 2 mg/kg I: 1 mg/kg/hr |
32 with high dose insulin | n/s | CI was 5.1 L/min/m2 and SVR was 400 dyn×sec×cm−5 before MB. BP increased from 75/40 to 90/75 mmHg and HR decreased from 120 to 90 bpm after MB |
| Flynn and Sladen, 2009, United States(41) | 14 y/o female with shock after lung transplant | B: 1.5 mg/kg | 73 | 3.3 by 10 min | BP improved and norepinephrine, epinephrine, vasopressin and phenylephrine weaned after MB. |
| Rodrigues et al. 2007, Brazil(42) | 23 y/o female with anaphylactic shock | B: 1.5 mg/kg I: 1mg/kg/hr for 1 hour |
N/s | N/s | Reversal of shock, angioedema, urticaria and dyspnea with 5 minutes of MB |
| Taylor and Holtby, 2005, Canada(43) | 10 y/o female with shock due to CHD and sepsis | B: 2 mg/kg twice I: 1 mg/kg/hr |
60 | n/s | MB was administered during CPB and vital signs remained stable |
| Pagni et al, 2000, United States(44) | 20 y/o male with shock due to CHD | B: 2 mg/kg over 30 min | 72.5 | 17.5 | BP increased from 80/51 to 118/59 mmHg, SVR increased from 538 to 842 dyn×sec×cm−5, HR decreased from 130 to 110 bpm and CI decreased from 3.0 to 1.6 L/min/m2 1 hr after MB |