Table 3.

Level of Evidence.

Author(s): Ka Ting Ng, Pei En Kwok, Wei En Lim, Mohd Shahnaz Bin Hasan, Rafidah Atan, Nor’ Azim Bin Mohammed Yunus, Mohd Fitry Zainal Abidin.

Question: Methylene Blue compared to Placebo for Septic Shock in Adults.

Setting: Septic Shock Adult Patients.

Certainty assessment							N° of patients		Effect
N° of studies	Study design	Risk of bias	Inconsistency	Indirectness	Imprecision	Other considerations	Methylene Blue	Placebo	Relative (95% CI)	Absolute (95%CI)	Certainty	Importance
Mean Arterial Pressure (mmHg)
4	Randomized trials	Seriousa	Seriousb	Not serious	Seriousc	None	142	144	‒	MD 2.94 higher (1.52 higher to 4.36 higher)	⊕○○○ Very low
Mortality Rate
3	Randomized trials	Seriousa	Not serious	Not serious	Seriousc	None	27/147 (18.4%)	39/112 (34.8%)	OR 0.49 (0.27 to 0.88)	141 fewer per 1,000 (from 222 fewer to 28 fewer)	⊕⊕○○ Low
Serum Lactate (mmoL.L-1)
2	Randomized trials	Seriousa	Not serious	Not serious	Seriousc	None	228	185	‒	MD 0.76 lower (1.22 lower to 0.31 lower)	⊕⊕○○ Low
PaO2/FiO2 (ratio of arterial oxygen partial pressure to fractional inspired oxygen)
2	Randomized trials	Seriousa	Not serious	Not serious	Seriousc	None	65	66	‒	MD 34.78 higher (8.94 higher to 60.61 higher)	⊕⊕○○ Low
Heart Rate (bpm)
3	Randomized trials	Seriousa	Not serious	Not serious	Seriousc	None	280	190	‒	MD 2.31 lower (5.88 lower to 1.27 higher)	⊕⊕○○ Low
Length of Hospital Stay (days)
2	Randomized trials	Seriousa	Not serious	Not serious	Seriousc	None	55	56	‒	MD 1.94 lower (3.79 lower to 0.08 lower)	⊕⊕○○ Low

CI, Confidence Interval; MD, Mean Difference; OR, Odds Ratio.

Explanations:

^aHalf of the included studies possess high or unclear risk of bias.

^bHigh degree of heterogeneity.

^cSample size of each arm < 400.