Methylene Blue for Refractory Shock in Polytraumatized Patient: A Case Report

• DOI: 10.1016/j.jemermed.2018.06.037
• Publication Date: 2018-08-16T10:39:37Z
• Authors: Leila Costa Volpon; Paulo Roberto Bar...; Gisele Douradinho...; Maurício Godinho; Sandro Scarpelini; Fabio Carmona; Ana Paula de Carv...
• Keywords: Male; Blood Pressure; Shock, Hemorrhagic; Intensive Care Units, Pediatric; 3. Good health; Methylene Blue; 03 medical and health sciences; 0302 clinical medicine; Child, Preschool; Humans; Wounds and Injuries; Hypotension

Methylene blue (MB) has been advocated for the treatment of shock refractory to standard measures. MB is proposed to increase blood pressure in shock by interfering with guanylate cyclase and nitric oxide synthase (NOS) activity. Several studies have evaluated the vasoconstrictive and positive inotropic effects of MB in septic shock patients. However, there is a paucity of studies involving trauma patients.A 4-year-old boy was hit by a truck while riding his bicycle and was treated with fluid resuscitation at the emergency department and then taken to the operating room for damage-control surgery. He had liver, diaphragm, rectal, and thoracic injuries. At the pediatric intensive care unit (PICU), he remained hypotensive despite volume, dopamine, epinephrine, and norepinephrine infusion. A dose of 0.5 mg/kg of i.v. MB was administered. During the next 2 h after MB administration, we were able to wean him off norepinephrine, and doses of epinephrine and dopamine were reduced. Ultimately, he was discharged from the PICU 13 days later in good condition. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Trauma patients who have experienced bleeding and survived the initial insult are still at risk of dying from continuing systemic hypoperfusion and the resultant multiple organ dysfunctions. Use of a low dose of MB as an adjuvant to treat shock might improve survival of these patients.