2026 Southeastern Residency Conference

Impact of Early Methylene Blue on Vasopressor-Free Days in Medical ICU Patients with Septic Shock

Purpose: Septic shock remains a leading cause of intensive care unit (ICU) mortality despite standard therapies such as early antibiotics, fluids, vasopressors, and corticosteroids. Methylene blue has been utilized as an adjunctive agent in the treatment of septic shock by targeting nitric-oxide mediated vasodilation. However, data is lacking. The purpose of this study is to evaluate the impact of early methylene blue administration on vasopressor alive and free days at 28-days in adult patients with septic shock in the medical ICU.

Methods: This single-center, retrospective, cohort study will include adult patients admitted to the medical ICU with septic shock between January 1, 2022 and June 30, 2025 who received norepinephrine, vasopressin, and adjunctive hydrocortisone. The intervention group will consist of patients who additionally received methylene blue within 36 hours of vasopressor initiation and met prespecified inclusion/exclusion criteria. The control group will consist of patients meeting the same inclusion/exclusion criteria but did not receive methylene blue. The primary outcome is vasopressor alive and free days at day 28. Secondary outcomes include daily cumulative vasopressor dose during the first 72 hours after vasopressor initiation, time to vasopressor discontinuation, recurrence of septic shock, ICU and hospital length of stay, and 28-day mortality. Those who receive methylene blue will be assessed for shock liver/liver failure as evidenced by elevated liver function tests three times the upper limit of normal or total bilirubin ≥2 mg/dL, and documentation of serotonin syndrome within 5 days after initiation of vasopressors. Other safety outcomes will include arrhythmias and limb or mesenteric ischemia during the 28-day follow-up period. Data will be collected from the electronic medical record (EMR), recorded using REDCap, and analyzed using appropriate statistical tests.

Results: In progress