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. 2021 Apr 26;3(4):e0408.
doi: 10.1097/CCE.0000000000000408. eCollection 2021 Apr.

Hydroxocobalamin in Refractory Septic Shock: A Retrospective Case Series

Alicia J Sacco  1   2 , Cody A Cunningham  3 , Heidi E Kosiorek  4 , Ayan Sen  1
Affiliations

Hydroxocobalamin in Refractory Septic Shock: A Retrospective Case Series

Alicia J Sacco et al. Crit Care Explor. .

Abstract

Refractory septic shock is associated with high morbidity and mortality. Hydroxocobalamin is used to treat postoperative vasoplegia; however, data supporting its use in the setting of refractory septic shock is limited and restricted to case reports. This study evaluates the effect of hydroxocobalamin on mean arterial pressure and vasopressor requirements in a series of patients with refractory septic shock.

Design: Single-center, retrospective analysis.

Setting: Urban, tertiary-care ICU.

Patients: Adult ICU patients with refractory septic shock treated with hydroxocobalamin between August 2018 and January 2020.

Interventions: Hydroxocobalamin 5 g IV infusion.

Measurements and main results: Twenty-six patients were included for the analysis. Administration of hydroxocobalamin was associated with an increase in mean arterial pressure at 1, 6, and 24 hours postdose (+16.3, +14.3, and +16.3 mm Hg, respectively; p < 0.001). Increase in mean arterial pressure from baseline remained statistically significant when controlling for sex, age, and comorbid conditions. There was no change in the norepinephrine equivalents patients required 1 hour following hydroxocobalamin administration, but a statistically significant decrease in norepinephrine equivalent was observed at 6 and 24 hours postdose (p < 0.001).

Conclusions: Hydroxocobalamin provides sustained hemodynamic benefit at 24 hours in patients with refractory septic shock.

Keywords: adult; critically ill; hydroxocobalamin; nitric oxide; septic shock; vasoplegia.

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Conflict of interest statement

The authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Boxplot of patient data over time. Each dot represents one patient. A, Mean arterial pressure over time. B, Norepinephrine equivalent dose over time. MAP = mean arterial pressure, NE = norepinephrine equivalent.
See this image and copyright information in PMC

References

    1. Singer M, Deutschman CS, Seymour CW, et al. . The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016; 315:801–810 - PMC - PubMed
    1. Jentzer JC, Vallabhajosyula S, Khanna AK, et al. . Management of refractory vasodilatory shock. Chest. 2018; 154:416–426 - PubMed
    1. Khanna A, English SW, Wang XS, et al. ; ATHOS-3 Investigators. Angiotensin II for the treatment of vasodilatory shock. N Engl J Med. 2017; 377:419–430 - PubMed
    1. Bakker J, Grover R, McLuckie A, et al. ; Glaxo Wellcome International Septic Shock Study Group. Administration of the nitric oxide synthase inhibitor NG-methyl-L-arginine hydrochloride (546C88) by intravenous infusion for up to 72 hours can promote the resolution of shock in patients with severe sepsis: Results of a randomized, double-blind, placebo-controlled multicenter study (study no. 144-002). Crit Care Med. 2004; 32:1–12 - PubMed
    1. Kirov MY, Evgenov OV, Evgenov NV, et al. . Infusion of methylene blue in human septic shock: A pilot, randomized, controlled study. Crit Care Med. 2001; 29:1860–1867 - PubMed