Methylene Blue in Septic Shock: A Systematic Review and Meta-Analysis.

Q4 Medicine Critical care explorations Pub Date : 2024-06-21 eCollection Date: 2024-07-01 DOI:10.1097/CCE.0000000000001110
Shannon M Fernando, Alexandre Tran, Karim Soliman, Barbara Flynn, Thomas Oommen, Li Wenzhe, Neill K J Adhikari, Salmaan Kanji, Andrew J E Seely, Alison E Fox-Robichaud, Randy S Wax, Deborah J Cook, François Lamontagne, Bram Rochwerg
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引用次数: 0

Abstract

Objectives: Although clinicians may use methylene blue (MB) in refractory septic shock, the effect of MB on patient-important outcomes remains uncertain. We conducted a systematic review and meta-analysis to investigate the benefits and harms of MB administration in patients with septic shock.

Data sources: We searched six databases (including PubMed, Embase, and Medline) from inception to January 10, 2024.

Study selection: We included randomized clinical trials (RCTs) of critically ill adults comparing MB with placebo or usual care without MB administration.

Data extraction: Two reviewers performed screening, full-text review, and data extraction. We pooled data using a random-effects model, assessed the risk of bias using the modified Cochrane tool, and used Grading of Recommendations Assessment, Development, and Evaluation to rate certainty of effect estimates.

Data synthesis: We included six RCTs (302 patients). Compared with placebo or no MB administration, MB may reduce short-term mortality (RR [risk ratio] 0.66 [95% CI, 0.47-0.94], low certainty) and hospital length of stay (mean difference [MD] -2.1 d [95% CI, -1.4 to -2.8], low certainty). MB may also reduce duration of vasopressors (MD -31.1 hr [95% CI, -16.5 to -45.6], low certainty), and increase mean arterial pressure at 6 hours (MD 10.2 mm Hg [95% CI, 6.1-14.2], low certainty) compared with no MB administration. The effect of MB on serum methemoglobin concentration was uncertain (MD 0.9% [95% CI, -0.2% to 2.0%], very low certainty). We did not find any differences in adverse events.

Conclusions: Among critically ill adults with septic shock, based on low-certainty evidence, MB may reduce short-term mortality, duration of vasopressors, and hospital length of stay, with no evidence of increased adverse events. Rigorous randomized trials evaluating the efficacy of MB in septic shock are needed.

Registration: Center for Open Science (https://osf.io/hpy4j).

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亚甲蓝在脓毒性休克中的应用:系统综述与 Meta 分析。
目的:尽管临床医生可在难治性脓毒性休克中使用亚甲蓝(MB),但亚甲蓝对患者重要预后的影响仍不确定。我们进行了一项系统性综述和荟萃分析,以研究在脓毒性休克患者中使用亚甲蓝的益处和害处:我们检索了从开始到 2024 年 1 月 10 日的六个数据库(包括 PubMed、Embase 和 Medline):我们纳入了成人重症患者的随机临床试验(RCT),这些试验比较了甲基溴与安慰剂或不使用甲基溴的常规护理:两名审稿人进行了筛选、全文审阅和数据提取。我们使用随机效应模型对数据进行了汇总,使用修改后的 Cochrane 工具评估了偏倚风险,并使用建议评估、开发和评价分级法对效果估计的确定性进行了评级:我们纳入了六项研究性试验(302 名患者)。与服用安慰剂或不服用甲基溴相比,甲基溴可降低短期死亡率(RR [风险比] 0.66 [95% CI, 0.47-0.94],确定性低)和住院时间(平均差异 [MD] -2.1 d [95% CI, -1.4 to -2.8],确定性低)。与不使用甲基溴相比,甲基溴还可缩短使用血管加压药的时间(MD -31.1 小时[95% CI,-16.5 至 -45.6],确定性低),并可增加 6 小时的平均动脉压(MD 10.2 毫米汞柱[95% CI,6.1 至 14.2],确定性低)。甲基溴对血清高铁血红蛋白浓度的影响不确定(MD 0.9% [95% CI, -0.2% to 2.0%],确定性很低)。我们没有发现任何不良事件方面的差异:结论:在患有脓毒性休克的成人重症患者中,根据低确定性证据,甲基溴可降低短期死亡率、缩短血管加压时间和住院时间,但没有证据表明不良事件会增加。需要进行严格的随机试验,评估甲基溴对脓毒性休克的疗效:开放科学中心 (https://osf.io/hpy4j)。
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来源期刊
CiteScore
5.70
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审稿时长
8 weeks
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