The use of methylene blue in adult patients with septic shock: a systematic review and meta-analysis
O uso do azul de metileno em pacientes adultos com choque séptico: uma revisão sistemática e meta-análise
Ka Ting Ng, Pei En Kwok, Wei En Lim, Wan Yi Teoh, Mohd Shahnaz Hasan, Mohd Fitry Zainal Abidin
Abstract
Objectives
Methylene blue exerts its vasopressor properties by inhibiting nitric oxide-mediated vasodilation. Recent studies have advocated the use of methylene blue as a rescue therapy for patients with septic shock. The primary aim was to investigate the effect of methylene blue on the mean arterial pressure among adult patients with septic shock.
Methods
Databases of MEDLINE, EMBASE, and CENTRAL were searched from their inception date until October 2023. Randomized Clinical Trials (RCT) comparing methylene blue and placebo in adults with septic shock were included.
Results
Our systematic review included 5 studies (n = 257) for data analysis. As compared to the placebo, our pooled analysis showed that methylene blue significantly increased mean arterial pressure (MD: 1.34 mmHg, 95% CI 0.15 to 2.53, p = 0.03, level of evidence: very low). Patients who were given methylene blue were associated with statistically lower mortality rate (OR = 0.49, 95% CI 0.27 to 0.88, p = 0.02, level of evidence: low), reduced serum lactate levels (MD:-0.76 mmoL.L-1, 95% CI-1.22 to-0.31, p = 0.0009, level of evidence: low), reduced length of hospital stay (MD:-1.94 days, 95% CI-3.79 to-0.08, p = 0.04, level of evidence: low), and increased PaO2/FiO2 (MD: 34.78, 95% CI 8.94 to 60.61, p = 0.008, level of evidence: low).
Conclusions
This meta-analysis demonstrated that methylene blue administration was associated with an increased in mean arterial pressure and PaO2/FiO2 ratio, along with a reduction in mortality rates, serum lactate levels, and length of hospital stay. However, substantial degree of heterogeneity and inadequate number of studies with low level of evidence warrant future adequately powered RCTs to affirm our results.
Keywords
Resumo
Introdução
O azul de metileno exerce suas propriedades vasopressoras inibindo a vasodilatação mediada por óxido nítrico. Estudos recentes têm defendido o uso do azul de metileno como terapia de resgate para pacientes com choque séptico. O objetivo principal era investigar o efeito do azul de metileno na pressão arterial média entre pacientes adultos com choque séptico.
Métodos
Os bancos de dados MEDLINE, EMBASE e CENTRAL foram pesquisados desde a data de início até outubro de 2023. Ensaios clínicos randomizados (ECR) comparando azul de metileno e placebo em adultos com choque séptico foram incluídos.
Resultados
Nossa revisão sistemática incluiu 5 estudos (n = 257) para análise de dados. Em comparação com o placebo, nossa análise combinada mostrou que o azul de metileno aumentou significativamente a pressão arterial média (MD: 1,34 mmHg, IC de 95% 0,15 a 2,53, p = 0,03, nível de evidência: muito baixo). Pacientes que receberam azul de metileno foram associados a uma taxa de mortalidade estatisticamente menor (OR = 0,49, IC 95% 0,27 a 0,88, p = 0,02, nível de evidência: baixo), níveis séricos de lactato reduzidos (MD: -0,76 mmoL.L-1, IC 95% -1,22 a -0,31, p = 0,0009, nível de evidência: baixo), tempo de internação hospitalar reduzido (MD: -1,94 dias, IC 95% -3,79 a -0,08, p = 0,04, nível de evidência: baixo) e aumento de PaO2/FiO2 (MD: 34,78, IC 95% 8,94 a 60,61, p = 0,008, nível de evidência: baixo).
Conclusão
Esta meta-análise demonstrou que a administração de azul de metileno foi associada a um aumento na pressão arterial média e na razão PaO2/FiO2, juntamente com uma redução nas taxas de mortalidade, níveis de lactato sérico e tempo de internação hospitalar. No entanto, o grau substancial de heterogeneidade e o número inadequado de estudos com baixo nível de evidência justificam futuros ECRs adequadamente energizados para afirmar nossos resultados.
Palavras-chave
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Submitted date:
07/05/2024
Accepted date:
11/21/2024
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