Background- In covid-19 pneumonia, due to excessive formation of cytokines and hypercoagulability, lung damage occurs and may progress to multiorgan failure and vasoplegic shock. There have been studies where methylene blue, when given intravenously to treat covid patients, showed positive outcomes. Still, no study or case report has shown its effect when given via nebulization.
Methods- In this pilot study, In all patients, Routine blood investigations, Arterial blood gas (ABG), serum lactate dehydrogenase (LDH) level, coagulation profile, d-dimer and chest x-ray were sent. As a standard of care protocol, the patient received supplemental oxygen support, intravenous fluids, antiviral agent, antibiotics, anticoagulants and steroid therapy if neededwe have used methylene blue nebulisation in Post COVID-19 patients to improve oxygenation. All post covid patients were nebulized with methylene blue [1ml (10mg) + 4ml Normal Saline] 12 hourly and an ABG sample was obtained after 1 hour of nebulization with standard of care ICU management.
Results-Four of six patients improved and were discharged from ICU, while two patients expired. Their bad outcome may be due to comparatively worse conditions at admission, having high SOFA scores and APACHE II scores that themselves predict high mortality. HRCT has been improved in all four survived patients and this improvement was found statistically significant (P< 0.001).
Conclusion- In our study we concluded that Methylene blue nebulisation seems to be effective novel method for post covid patients in reducing fibrosis and increasing oxygenation with better intensive care outcome.