Patients
death, allergy, infection, septic shock, coronavirus disease, hemorrhagic, obstructive or hypovolemic shock
INFECTION, ALLERGY, GLUCOSE-6-PHOSPHATE DEHYDROGENASE DEFICIENCY, SEPTIC SHOCK
Patients aged ≥ 18 years with septic shock as defined by Sepsis-3 criteria (highly suspected or confirmed infection, requiring norepinephrine to maintain a MAP ≥ 65 mmHg, and serum lactate > 2 mmol/L after adequate fluid resuscitation) [Exclusion criteria included > 24 h since initiation of norepinephrine, pregnancy, high probability of death within 48 h, concurrent hemorrhagic, obstructive or hypovolemic shock, pending damage control surgery, major burn injury, personal or familiar history of glucose-6-phosphate dehydrogenase deficiency, allergy to methylene blue, phenothiazines, or food dyes, recent intake (4-weeks) of selective serotonin re-uptake inhibitors, and refusal of the patient or decision maker to participate. During the beginning of coronavirus disease (COVID-19) pandemic, data safety monitoring board did not allow us to recruit patients with this diagnosis, due to the unknown pathophysiologic underpinnings and the uncertainties about response to MB.