Methylene Blue and Burns

Nitric oxide (NO) is a central mediator of many physiological and pathophysiological events. After a thermal injury, an increase in NO was observed in the plasma and urinary levels, but the real importance of this fact is unknown. The guanylate cyclase inhibition by methylene blue (MB) has been proven, in basic and clinical studies, as an adjuvant treatment option in cases of catecholamine-resistant vasoplegia. Its use is safe, generally lifesaving, and the pharmacological inhibition of NO interferes not only in the reversal of vasoplegia but also in vascular permeability, often caused by the systemic inflammatory response associated with burns. Increasing experimental and clinical studies suggest MB as a viable, safe, and useful coadjuvant therapeutic tool for fluid resuscitation.