Title

Effects of a single bolus of hydroxocobalamin on hemodynamics in vasodilatory shock

Authors

Lindsay A. Ritter, MedStar Washington Hospital Center, Department of Critical Care, Washington, DC, USA. Electronic address: lindsay.a.ritter@medstar.net.
Mary Maldarelli, University of Maryland School of Medicine, Department of Medicine, Baltimore, MD, USA. Electronic address: mary.maldarelli@som.umaryland.edu.
Michael T. McCurdy, University of Maryland School of Medicine, Department of Medicine, Division of Pulmonary and Critical Care, Baltimore, MD, USA. Electronic address: MMcCurdy@umm.edu.
David P. Yamane, George Washington University School of Medicine and Health Sciences, Department of Anesthesiology and Critical Care Medicine, Department of Emergency Medicine, Washington, DC, USA. Electronic address: DAYamane@mfa.gwu.edu.
Danielle Davison, George Washington University School of Medicine and Health Sciences, Department of Anesthesiology and Critical Care Medicine, Washington, DC, USA. Electronic address: DDavison@mfa.gwu.edu.
Christopher Parrino, University of Maryland School of Medicine, Baltimore, MD, USA. Electronic address: Christopher.Parrino@som.umaryland.edu.
David N. Yim, University of Maryland School of Medicine, Baltimore, MD, USA. Electronic address: David.Yim@som.umaryland.edu.
Myounghee Lee, University of Maryland Medical Center, Baltimore, MD, USA. Electronic address: MLee1@umm.edu.
Michael A. Mazzeffi, George Washington University School of Medicine and Health Sciences, Department of Anesthesiology and Critical Care Medicine, Washington, DC, USA. Electronic address: mimazzeffi@mfa.gwu.edu.
Jonathan H. Chow, George Washington University School of Medicine and Health Sciences, Department of Anesthesiology and Critical Care Medicine, Washington, DC, USA. Electronic address: JChow@mfa.gwu.edu.

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.

Department

Anesthesiology and Critical Care Medicine

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