Hydroxocobalamin in Refractory Septic Shock: A Retrospective Case Series

OBJECTIVES: 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.