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 methylene blue as an adjunct in resuscitation. However, the clinical application of this agent remains controversial and debated in practice. This systematic review and meta-analysis aimed to evaluate the use of adjunctive methylene blue in managing vasodilatory shock in both adult and pediatric patients. Multiple databases and gray literature sources were searched with search terms including Methylene Blue, Shock, Sepsis, and Hypotension, covering studies published from 1963 to November 2024. Studies were included without language restrictions; however, non-randomized controlled trials and studies where methylene blue 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). Methylene blue significantly reduced mortality (OR=0.48, 95% 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, methylene blue significantly reduced vasopressor requirements (MD=-0.43, 95% CI -0.49, -0.38, p
Altami et al. (Wed,) studied this question.