Abstract / Summary
This study aimed to evaluate previous clinical experience with methylene blue (MB), reported indications, dosing and administration preferences, monitoring and safety practices, and barriers to use among physicians working in pediatric intensive care in Türkiye. This national, cross-sectional, online survey was conducted between April 1 and 15, 2026, among faculty members, pediatric intensive care specialists, and pediatric intensive care subspecialty fellows practicing in Türkiye. A 24-item questionnaire developed by the investigators based on the literature was distributed through individual messages and professional WhatsApp groups. Of 70 participants, 51 (72.9%; 95% confidence interval [CI], 61.5–81.9) reported having used MB at least once during their professional practice. Use did not differ significantly according to professional title, institution type, pediatric intensive care unit bed capacity, or duration of professional experience (all p > 0.05). All respondents with previous MB experience reported use for catecholamine-resistant septic shock. The most common administration strategy was a bolus followed by continuous infusion (70.6%). Among respondents reporting a bolus dose, 76.2% preferred 1 mg/kg; among those reporting an infusion rate, 47.7% preferred 1 mg/kg/h. The vasoactive-inotropic score (VIS) was used to guide MB initiation by 45.1%. Inquiry and/or screening for glucose-6-phosphate dehydrogenase (G6PD) deficiency was reported routinely by 21.6%, and 49.0% answered “Yes” to assessment of ventricular function by echocardiography/point-of-care ultrasound (POCUS). Transient hemodynamic improvement was reported by 58.8% and marked and sustained clinical improvement by 17.6%. Among non-users, the most frequently reported barrier was lack of familiarity or experience (78.9%). Previous clinical experience with methylene blue was frequently reported among pediatric intensive care physicians participating in this survey in Türkiye. However, substantial variation was observed in dosing, treatment timing, hemodynamic monitoring, and safety practices. These findings highlight the need for standardized protocols, educational initiatives, and prospective multicenter studies addressing MB use in pediatric refractory shock. not applicable.