Effects of a single bolus of hydroxocobalamin on hemodynamics in vasodilatory shock
Document Type
Journal Article
Publication Date
2-1-2022
Journal
Journal of critical care
Volume
67
DOI
10.1016/j.jcrc.2021.09.024
Keywords
Hydroxocobalamin; Septic shock; Vasoplegia; Vitamin B12
Abstract
PURPOSE: Hydroxocobalamin has been observed to cause transient hypertension in healthy subjects, but rigorous studies examining its efficacy are lacking. MATERIALS AND METHODS: Adults in shock who received hydroxocobalamin from 2017 to 2021 were analyzed retrospectively. Hourly hemodynamics from 24 h before and after treatment were collected, and the difference and hourly change of mean arterial pressure (MAP), systolic blood pressure (SBP), diastolic blood pressure (DBP), and norepinephrine-equivalent dose (NED) were examined in mixed-effects models. RESULTS: This study included 3992 hemodynamic data points from 35 patients and is the largest case series to date. In the mixed effects model, there was no difference in MAP 24-h after hydroxocobalamin administration (estimated fixed effect [EFE] -0.2 mmHg, p = 0.89). A two-piecewise mixed model found that the hourly change in MAP was not different from zero in either the pre-administration (EFE 0.0 mmHg/h, p = 0.80) or post-administration segments (EFE 0.0 mmHg/h, p = 0.55). Analysis of the SBP, DBP, and NED also found similar insignificant results. CONCLUSIONS: Although hydroxocobalamin has been observed to cause hypertension in healthy subjects, our results suggest that in patients with shock, hydroxocobalamin may not be effective in improving hemodynamics at 24 h after administration.
APA Citation
Ritter, Lindsay A.; Maldarelli, Mary; McCurdy, Michael T.; Yamane, David P.; Davison, Danielle; Parrino, Christopher; Yim, David N.; Lee, Myounghee; Mazzeffi, Michael A.; and Chow, Jonathan H., "Effects of a single bolus of hydroxocobalamin on hemodynamics in vasodilatory shock" (2022). GW Authored Works. Paper 365.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/365
Department
Anesthesiology and Critical Care Medicine