• Lindsay A Ritter, Mary Maldarelli, Michael T McCurdy, David P Yamane, Danielle Davison, Christopher Parrino, David N Yim, Myounghee Lee, Michael A Mazzeffi, and Jonathan H Chow.
• MedStar Washington Hospital Center, Department of Critical Care, Washington, DC, USA. Electronic address: lindsay.a.ritter@medstar.net.
• J Crit Care. 2022 Feb 1; 67: 66-71.

PurposeHydroxocobalamin has been observed to cause transient hypertension in healthy subjects, but rigorous studies examining its efficacy are lacking.Materials And MethodsAdults 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.ResultsThis 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.ConclusionsAlthough 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.Copyright © 2021 Elsevier Inc. All rights reserved.

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