ReviewAdvances in therapy2020
Vasopressor-Sparing Action of Methylene Blue in Severe Sepsis and Shock: A Narrative Review.
Review in Advances in therapy, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
26 citing papers in PubMed, 4 syntheses or guidelines pooled it, 83 citations in OpenAlex.
- [S3 guideline on sepsis-prevention, diagnosis, therapy, and follow-up care-update 2025].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2025Guideline
- Methylene Blue in Septic Shock: A Systematic Review and Meta-Analysis.Critical care explorations · 2024Pooled it
- Methylene blue in sepsis and septic shock: a systematic review and meta-analysis.Frontiers in medicine · 2024Pooled it
- Efficacy and safety of methylene blue in patients with vasodilatory shock: A systematic review and meta-analysis.Frontiers in medicine · 2022Pooled it
- Comparative study between high and low dose methylene blue infusion in septic cancer patients: a randomized, blinded, controlled study.BMC anesthesiology · 2025Trial
- The Effect of Methylene Blue on Sublingual Microcirculation in Patients with Septic Shock: A Randomized Controlled Trial.Drug design, development and therapy · 2025Trial
- Early adjunctive methylene blue in patients with septic shock: a randomized controlled trial.Critical care (London, England) · 2023Trial
- Early Methylene Blue for Mortality Reduction in High-Dose VasoPREssor-Dependent Septic Shock (EMPRESS): protocol for a multicenter randomized controlled trial.Scandinavian journal of trauma, resuscitation and emergency medicine · 2026Article
- Article
- Methylene blue in the critical care setting.World journal of critical care medicine · 2025Review
- Fifty shades of green and blue: autopsy findings after administration of xenobiotics.Forensic science, medicine, and pathology · 2025Review
- Methylene Blue in Septic Shock: Emerging Evidence, Clinical Applications, and Future Directions.Cureus · 2025Review
- Blue Hopes, Red Flags: The Methylene Blue Dilemma in Sepsis Shock.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2025Article
- Effects of Early Use of Methylene Blue and Vasopressin on Noradrenaline Dose in Septic Shock: A Randomized Controlled Trial.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2025Article
- Methylene Blue and Blood Transfusion in Hemorrhagic Shock Resuscitation: An Experimental Porcine Study.Brazilian journal of cardiovascular surgery · 2024Article
- Article
- Administration of methylene blue in septic shock: pros and cons.Critical care (London, England) · 2024Review
- Methylene blue therapy in addition to standard treatment for acute-phase septic shock: a pilot randomized controlled trial.Frontiers in medicine · 2024Article
- Can Use of Intravenous Methylene Blue Improve the Hemodynamics and Outcome of the Patients with Refractory Septic Shock? An Observational Study.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2023Article
- Norepinephrine May Exacerbate Septic Acute Kidney Injury: A Narrative Review.Journal of clinical medicine · 2023Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 4 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Shock is a serious acute circulatory failure leading to inadequate oxygen delivery to the cells. Its treatment is mainly based on circulating fluid optimization, and vasopressors to provide an adequate mean arterial pressure and microcirculatory flow. Norepinephrine is the drug of choice, but high dosages may be responsible for several side effects, including increased myocardial oxygen consumption, dysrhythmias, and peripheral and organ ischemia. Moreover, some patients are "non-responders" to first-line norepinephrine treatment. Hence, other drugs have been proposed to reach and maintain the hemodynamic target. In general, they are described as catecholamine-sparing agents. Among others, the most used are vasopressin, corticosteroids, and angiotensin II. Methylene blue (MB) represents a further option, even though its use is still a topic of controversy. This review article tries to summarize what is known and unknown about the actions of MB in patients in shock. It reduces excessive production of nitric oxide via blockade of guanylate cyclase in shock states. At present, it appears the MB provides positive results in septic shock, if administered early. Further randomized controlled trials are warranted regarding its use to provide more precise indications to physicians involved in the treatment of such patients.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.