Are You Team Blue or Red In Septic Shock?

Introduction

Hey there, Resuscitationists! Today, we're diving into some really interesting stuff on sepsis presented by Eddy Gutierrez from the ResusX:Reset. He's talking about using methylene blue and hydroxycobalamin in patients with refractory septic shock. Now, if you're scratching your head wondering what do these meds have to do with sepsis, don't sweat it...we're going to review his talk together!

The Gritty Reality of Septic Shock

First things first, in 2023 septic shock still has high mortality rates, and despite us throwing the kitchen sink at it - fluids, antibiotics, vasopressors like norepinephrine and vasopressin - we're still seeing too many patients die. That's why we are constantly on the lookout for better tools.

Methylene Blue to the Rescue?

Enter methylene blue. No, it's not a new Crayola color. This centenarian drug, initially used to tackle malaria, is making a comeback – but this time, in the world of septic shock. How does it work? It's all about stopping that crazy vasodilation that comes with septic shock. But it's not perfect, methylene blue has its quirks; potentially messing with your serotonin levels or playing tricks on your oximetry readings. And if your patients are in the G6PD deficiency club, this drug shouldn't be used.

But here's the kicker: the "Shockham Blue trial" showed some promise - think quicker weaning off vasopressors and shorter stays in the ICU. Sounds good but unfortuantely it didn't move the needle on mortality rates, so the jury is still out.

Hydroxycobalamin: The Dark Horse

Not to be outdone, hydroxycobalamin, a form of vitamin B12, has also been considered. Similar to methylene blue, it targets the same troublemakers in septic shock. The side effects? A bit tamer, though it might turn your urine a funky red color. The "IV Hydroxycobalamin in Septic Shock" study, while small, showed a dip in vasopressor use. Interesting, right?

Wrapping It Up

So, what's the takeaway here? Methylene blue and hydroxycobalamin might just be agents that we've been waiting for in the fight against septic shock. But as with all great things in medicine, much more research is needed. When you're caring for a severely septic patient who isn't doing well, you might consider these two drugs.

Want To Watch The Lecture?

Check out ResusX:Reset here.