Methylene Blue for Refractory Shock in Children: A Systematic Review and Survey Practice Analysis.

Shock refractory to fluid and catecholamine therapy has significant morbidity and mortality in children. The use of methylene blue (MB) to treat refractory shock in children is not well described. We aim to collect and summarize the literature, and to describe physicians’ practice patterns, regarding the use of MB to treat shock in children. We conducted a systematic search of MEDLINE, Embase, PubMed, Web of Science and Cochrane for studies involving the use of MB for catecholamine refractory shock from database inception to 2019. Collected studies were analyzed qualitatively. To describe practice patterns of MB use, we electronically distributed to US-based pediatric critical care physicians. We assessed physician knowledge and experience with MB. Survey responses were quantitively and qualitatively evaluated. Pediatric critical and cardiac care units. Patients less than or equal to 25 years old with refractory shock treated with MB and attending physicians. None. 1293 abstracts met search criteria, 139 articles underwent full text review and 24 studies were included. Studies investigated refractory shock induced by a variety of etiologies and found that MB was generally safe and increased mean arterial blood pressure. There is overall lack of studies, low number of study patients, and low quality of studies identified. Our survey had a 22.5% response rate, representing 125 institutions. Similar proportions of physicians reported using (40%) or never even considering (43%) MB for shock. The most common reasons for not using MB were unfamiliarity with this drug, its proper dosing, and lack of evidentiary support. MB appears safe and may benefit children with refractory shock. There is a stark divide in familiarity and practice patterns regarding its use among physicians. Studies to formally assess safety and efficacy of MB in treating pediatric shock are warranted.

液体和儿茶酚胺治疗无效的休克在儿童中具有显著的发病率和死亡率。亚甲蓝（MB）用于治疗儿童难治性休克的情况尚未得到充分阐述。我们旨在收集和总结相关文献，并描述医生在使用MB治疗儿童休克方面的实践模式。 我们对MEDLINE、Embase、PubMed、Web of Science和Cochrane进行了系统检索，查找从数据库建立到2019年涉及使用MB治疗儿茶酚胺难治性休克的研究。对收集到的研究进行了定性分析。为了描述MB使用的实践模式，我们以电子方式向美国的儿科重症监护医生发放了问卷。我们评估了医生对MB的了解和使用经验。对调查问卷的回复进行了定量和定性评估。 儿科重症监护病房和心脏监护病房。 年龄小于等于25岁、使用MB治疗难治性休克的患者以及主治医生。 无。 1293篇摘要符合检索标准，139篇文章进行了全文审查，24项研究被纳入。研究调查了由多种病因引起的难治性休克，发现MB通常是安全的，并能提高平均动脉血压。总体上研究缺乏，研究患者数量少，且所确定研究的质量低。 我们的调查回复率为22.5%，代表125个机构。相似比例的医生报告使用（40%）或甚至从未考虑（43%）使用MB治疗休克。不使用MB最常见的原因是对这种药物不熟悉、其正确剂量以及缺乏证据支持。 MB似乎是安全的，可能对难治性休克儿童有益。医生在对其使用的熟悉程度和实践模式上存在明显差异。有必要进行研究以正式评估MB治疗儿科休克的安全性和有效性。