Physician in Social Service Year (Mexico) Universidad de Guanajuato Guadalupe, Zacatecas, Zacatecas, Mexico
Disclosure(s):
Ana De La Torre: No financial relationships to disclose
Background: Methylene blue (MB) has been regarded as a rescue therapy for refractory shock because it inhibits the production and action of nitric oxide in the vasculature, thereby decreasing vasodilation.
Methods: A 69-year-old woman who underwent a Bentall and De Bono procedure for ascending aortic aneurysmal dilation developed vasoplegic shock refractory to vasopressor therapy and was treated with methylene blue as adjunctive treatment.
Outcome: A 69-year-old woman was diagnosed with chronic severe type I-A aortic insufficiency and ascending aortic aneurysm measuring 54 mm. She underwent elective open-heart surgery with a Bentall–De Bono procedure. Following cardiopulmonary bypass, the patient developed ventricular fibrillation, which was successfully treated with defibrillation and epicardial pacing. Postoperative bleeding required blood transfusion and initiation of dual vasopressor therapy. In the intensive care unit, the patient developed refractory vasoplegic shock, characterized by adequate cardiac index and low systemic vascular resistance despite norepinephrine and vasopressin. Adjunctive methylene blue was administered at a dose of 2 mg/kg, followed by a second dose 40 minutes later, resulting in significant hemodynamic improvement and complete withdrawal of vasopressors. The patient was discharged from the ICU 96 hours after admission without organ failure.
Conclusion: These findings support its consideration as an adjunctive treatment for refractory shock. Furthermore, methylene blue represents a developing therapeutic option for vasoplegic shock in middle-income countries and in resource-limited settings.
