Elmati PR, Nagaradona T, Raghove V, Jagirdhar GSK, Surani S. Methylene blue in the critical care setting. World J Crit Care Med 2025; 14(3): 105350 [DOI: 10.5492/wjccm.v14.i3.105350]
Corresponding Author of This Article
Salim Surani, MD, Professor, Department of Medicine and Pharmacology, Texas AM University, 40 Bizzell Street, College Station, TX 77843, United States. srsurani@hotmail.com
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Praveen Reddy Elmati, Department of Anesthesiology, Saint Clair Hospital, Dover, NJ 07801, United States
Teja Nagaradona, Department of Medicine, St George University, School of Medicine, Granada SW17 0BD, West Indies
Vikas Raghove, Department of Anesthesia, IU Health Ball Memorial Hospital, Munice, IN 47303, United States
Gowthami Sai Kogilathota Jagirdhar, Department of Gastroenterology, Saint Michaels Medical Center, Newark, NJ 07107, United States
Salim Surani, Department of Medicine and Pharmacology, Texas AM University, College Station, TX 77843, United States
Author contributions: Elmati PR and Jagirdhar GSK designed the overall concept and outline of the manuscript; Elmati PR, Raghove V, Jagirdhar GSK, and Nagaradona T performed the research and analyzed the data; Elmati PR, Raghove V, Jagirdhar GSK, Nagaradona T, and Surani S contributed to the manuscript’s writing and editing; and all authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Salim Surani, MD, Professor, Department of Medicine and Pharmacology, Texas AM University, 40 Bizzell Street, College Station, TX 77843, United States. srsurani@hotmail.com
Received: January 20, 2025 Revised: March 21, 2025 Accepted: April 21, 2025 Published online: September 9, 2025 Processing time: 181 Days and 0.3 Hours
Abstract
Methylene blue (MB) is a versatile medicine with a long history of use in various medical applications, including dye, antiseptic, and treatment for methemoglobinemia. It has a role in vasoconstriction, methemoglobin reduction, inhibition of guanylate cyclase, and anti-inflammatory effects. We reviewed PubMed and Google Scholar literature for relevant studies on MB in intensive care unit (ICU). We created search criteria using a combination of free text words, including MB, critical care, intensive care, sepsis, surgery, pharmacokinetics, and pharmacodynamics. Relevant articles published in the English language were analyzed and incorporated. MB has been used in managing patients with refractory shock, including septic shock, vasoplegic shock, surgical patients, and some instances of drug-induced hypotension. In conclusion, MB in the ICU is a promising medication for sepsis and vasoplegic shock. Further research with randomized trials on its long-term safety in the ICU, time of initiation, dose, and duration is necessary.
Core Tip: Methylene blue is a promising medication with various benefits due to its inhibition of guanylate cyclase, anti-inflammatory effects, and nitric oxide inhibition. It has been researched in septic shock, distributive shock in cardiac procedures, anaphylaxis, and organ transplant procedures. It is a safe medication based on literature with rare documented adverse events at lower doses. Its role as an adjunct to vasopressors needs to be further researched, including the definition of the dose, initiation time, and usage duration.
