Discussion
septic shock
ADVERSE EFFECTS, SEPTIC SHOCK
In this single-center RCT, we found that adjunctive MB administered within 24 h of septic shock diagnosis reduced time to vasopressor discontinuation, and importantly, no severe adverse effects were detected. The clinical implications of our results might shift the current understanding of MB as a rescue therapy [To our knowledge, this is the largest RCT comparing MB vs placebo in patients with septic shock. In the study by Kirov et al. in 2001, they randomized 20 patients with septic shock to placebo or a bolus injection of 2 mg/kg of MB, followed by a continuous 4-h infusion to a total dose of 5.75 mg/kg, and followed patients up to 24 h. Although more patients died in the control group (7 vs 3) and duration of vasopressor support was shorter in MB group (71 h vs 93 h), these differences were not significant [The most common use of MB for septic shock is reported as single infusions due to extrapolation from the predominant literature on CPB [Regarding potential adverse effects, two prior small non-randomized studies suggested that MB could induce worsening of oxygenation due to pulmonary vasoconstriction. Gachot et al. reported a significant decrease of PaO