Introduction: Methylene blue (MB) is an adjunctive treatment in children with septic shock. However, patient and treatment-level characteristics associated with its use are not well characterized. Methods: We identified septic shock (ICD-10: R56.21) hospitalizations among patients aged 0-21 years from January 2016 to October 2024 using the Pediatric Health Information System (PHIS) database. The cohort was limited to those hospitalized in an Intensive Care Unit (ICU). The primary outcome was Methylene blue (MB) use during hospitalization, which was identified by the clinical transaction classification code: 38792. We compared patient and treatment characteristics between those who did and those who did not receive MB using Chi-square tests or t-tests, as appropriate. Results: We identified 47,846 pediatric septic shock hospitalizations, of which 605 (1.2%) received MB. Overall, 46 of 49 (93.9%) of PHIS hospitals in this analysis used MB at least once during the study period. Among those who received MB, the highest proportion of MB use occurred in the South region (40%), followed by the Midwest (36%), West (18%), and Northeast (6%) (p < 0.001). There was no difference in the age of children who did versus did not receive MB (8 years IQR 0-16 vs. 9 years IQR 1-15; p=0.08). Male patients were more likely to receive MB (58.8% received MB vs. 51.5% did not receive MB; p< 0.001). A higher proportion of patients with complex chronic conditions (CCC) received MB (96.5% who received MB had CCC vs 88.4% who did not receive MB had CCC; p< 0.001). A higher proportion of patients supported with ECMO received MB (29.9% who received MB supported by ECMO vs 4.8% who did not receive MB supported by ECMO; p< 0.001). A higher proportion of patients who underwent congenital heart surgery received MB (20.8% who received MB underwent surgery vs 3.6% who did not receive MB underwent surgery; p< 0.001). Conclusions: While MB is rarely used for children hospitalized with septic shock, utilization varied significantly across patient characteristics, including medical complexity and geographic location.
Sears et al. (Sun,) studied this question.