Abstract
Although mortality rates associated with sepsis have gradually declined over the years, it remains a leading cause of death among hospitalized patients. One potential therapeutic approach involves the use of methyl ene blue (MB) as an adjunct in resuscitation. However, the clinical application of this agent remains controver sial and debated in practice. This systematic review and meta-analysis aimed to evaluate the use of adjunctive MB in managing vasodilatory shock in both adult and pediatric patients. Multiple databases and gray litera ture sources were searched with search terms including “MB,” “Shock,” “Sepsis,” and “Hypotension,” covering studies published from 1963 to November 2024. Studies were included without language restrictions; how ever, non-randomized controlled trials and studies where MB was administered outside the context of shock states were excluded. A total of 570 patients were included in the studies (283 in the MB group and 287 in the control group). MB significantly reduced mortality [odds ratio = 0.48, 95% confidence interval (CI) (0.31, 0.73), p-value = 0.0006]. There was no significant effect on mean arterial pressure [MD = 0.37, 95% CI (-0.32, 1.06), p-value = 0.30, I² = 86%] or heart rate [MD = 0.01, 95% CI (-0.70, 0.71), p-value = 0.98, I² = 86%]. However, MB significantly reduced vasopressor requirements [MD = -0.43, 95% CI (-0.49, -0.38), p < 0.00001]. Despite that, it did not reveal a significant improvement in hemodynamics, but MB demonstrated notable mortality reduc tion when added as an adjunct in septic patients. Furthermore, it demonstrated a reduction in vasopressor requirement. However, additional studies are required to support the results.

Key words: Methylene blue, adult and pediatric patients, vasodilatory shock, systematic review, meta-analysis