Use of methylene blue in early septic shock: A scoping review

Introduction: Septic shock is a severe medical emergency with high mortality, characterized by circulatory failure and dysfunction of vital organs. Despite initial fluid resuscitation, only 50% of patients respond, requiring the use of vasopressors. Methylene blue (MB) has emerged as a treatment for refractory vasoplegia, restoring vascular tone and reducing inflammatory cytokines; however, its use in the early stages of shock remains under-researched. The objective of this study is to explore the existing literature on the use of MB in the early stages of septic shock to evaluate its effectiveness and safety. Materials and Methods: An exploratory systematic review was conducted in accordance with PRISMA-ScR guidelines. Analytical or experimental human studies, retrospective or prospective, published up to February 25, 2025, were included. The databases searched included PubMed, Scopus, the International Clinical Trials Registry Platform (ClinicalTrials), OXFORD academy, and EBSCO. Terms such as “Early shock” and “Methylene Blue” were primarily searched. Results: A total of six publications published between 2001 and 2025 evaluated MB in septic shock. Most studies showed that early MB use improved hemodynamic parameters, reduced vasopressor duration, and showed possible immunomodulatory effects. No major safety concerns were reported across studies. Conclusion: MB may be considered as a complementary strategy in the management of septic shock, particularly in its early stages. Its positive impact on hemodynamics, its safety in controlled doses, and its potential role as an immunomodulator make it a promising therapeutic option.