Methylene Blue as a Third-line Vasopressor in Septic Shock

Inclusion Criteria: 1\. Meets Sepsis-3 Criteria (Suspected source of infection plus any 2 criteria of the qSOFA) 2 .Septic Shock (any patient requiring vasopressor therapy to maintain MAP \>65 mmHg or any patient with serum lactate \>2 mmol/dL even in the absence of hypovolemia ). 3\) Greater than 18 years old 4 ) ICU Admission Exclusion Criteria: Inability to obtain informed consent from an appropriate surrogate decision maker. Also: 1. Children less than 18 years old 2. Pregnant women or positive urinary pregnancy test in reproductive-aged women 3. Prisoners 4. Evolving myocardial infarction or known cardiomyopathy with documented EF\<35% 5. Known grade 3 diastolic dysfunction document by echocardiogram 6. Known hypersensitivity to thiazine dyes 7. Pulmonary hypertension that is currently requiring vasodilator therapy 8. Concurrent form of shock present or suspected: Obstructive, Neurogenic, Hemorrhagic 9. Known documented history of G6PD deficiency or favism 10. Active prior to admission medication prescription for a SSRI or SNRI , systemic heparin anticoagulation or other medications listed above (under Study Agent). These medications will be listed in the printed enrollment form. 11. Severe renal failure is a contraindication to use of ProvayBlue®.