• Laura Pasin, Michele Umbrello, Teresa Greco, Massimo Zambon, Federico Pappalardo, Martina Crivellari, Giovanni Borghi, Andrea Morelli, Alberto Zangrillo, and Giovanni Landoni.
• Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy. pasin.laura@hsr.it
• Crit Care Resusc. 2013 Mar 1;15(1):42-8.

ObjectiveTo evaluate the efficacy of methylene blue in raising mean arterial pressure in hypotensive patients.DesignA meta-analysis of randomised controlled trials.Data SourcesWe searched BioMedCentral, PubMed, Embase and the Cochrane Central Register of clinical trials.Data ExtractionInclusion criteria were random allocation to treatment and comparison of methylene blue versus any comparator. Exclusion criteria were duplicate publications, non-adult studies and no data on main outcomes. The primary end point was mean arterial blood pressure value 1 hour after the study drug administration; the secondary end points were mortality at the longest follow-up available, and cardiac index.Data SynthesisData from 174 patients in five randomised controlled studies were analysed. Mean arterial pressure rose in patients receiving methylene blue (weighted mean difference = 6.93 mmHg; 95% CI, 1.67 to 12.18; P for effect = 0.01; P for heterogeneity = 0.17; I2 = 41%). Only two studies reported the values of cardiac index with a non-statistically significant improvement in the methylene blue group (mean difference = 0.76 L/min/m2; 95% CI, ? 0.32 to 1.84; P for effect = 0.2). The overall mortality rate was 16% (14/88) among methylene blue treated patients and 23% (20/86) in the control group (odds ratio = 0.65; 95% CI, 0.21 to 2.08; P for effect = 0.5).ConclusionsMethylene blue increases arterial blood pressure and systemic vascular resistances in vasoplegic patients without a detrimental effect on survival.

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