Azul de metileno como terapia complementaria en el manejo del shock séptico refractario en los pacientes con cáncer: experiencia clínica

Abstract

Objective

To describe the clinical experience with the use of methylene blue as a complementary therapy in the management of refractory septic shock in a cohort of cancer patients.

Design

Retrospective cohort study.

Setting

High-complexity oncological Intensive Care Unit.

Participants

Ninety-four adult patients with confirmed cancer diagnoses admitted to the ICU between October 2022 and January 2024.

Interventions

No specific interventions were performed; retrospective data were analyzed.

Main outcome measures

Total norepinephrine dose before and after methylene blue administration, Total epinephrine dose before and after methylene blue administration, ICU mortality, Multiple organ dysfunction.

Results

A total of 94 oncology patients with septic shock and refractory vasoplegia were included, of which 44.7% were women, with a median age of 63 years. The predominant etiology was Gram-negative bacilli (35.1%). The group treated with methylene blue showed a higher need for mechanical ventilation (97.9 vs. 66%) and greater use of norepinephrine and vasopressin, although with a significant reduction in the cumulative dose of norepinephrine (from 15.08 to 11.3 mg, P < .05) and adrenaline compared to the control group. No significant reduction in mortality was observed with methylene blue (OR: 0.66; 95% CI: 0.25-1.7). Respiratory failure was the main predictor of mortality (OR: 15.1; 95% CI: 1.63-40.7). Methylene blue was not associated with adverse events.

Conclusions

The use of methylene blue as an adjuvant therapy in the management of refractory septic shock in oncology patients allows for a reduction in catecholamine dosage, demonstrating a vasopressor-sparing effect without being associated with significant adverse events. Although a trend toward a protective effect on mortality and organ dysfunction is observed, these results do not reach statistical significance. Hypoxemic respiratory failure is identified as the main predictor of poor prognosis in this population. Additional studies are needed to assess its effectiveness in different stages of septic shock and in specific subgroups of oncology patients.