Hydroxocobalamin as a Rescue Treatment for Refractory Vasoplegic Syndrome After Prolonged Cardiopulmonary Bypass

Burnes, Maigan L.; Boettcher, Brent T.; Woehlck, Harvey J.; Zundel, M. Tracy; Iqbal, Zafar; Pagel, Paul S.

doi:10.1053/j.jvca.2016.08.019

Cited by 46 publications

(35 citation statements)

References 24 publications

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“…The effect of increasing blood pressure was related to increased plasma concentrations of free and total cobalamins‐(III), especially at 5‐g and 10‐g doses . The mechanisms by which IV hydroxocobalamin mitigates catecholamine‐resistant vasodilatory shock are not firmly established, but hydroxocobalamin has been shown to scavenge, bind, and prevent the formation of NO and H 2 S . Due to this effect, IV hydroxocobalamin has been used in catecholamine refractory shock .…”

Section: The Interaction Between Vitamin B12 and Circulating Gasotranmentioning

confidence: 99%

“…Even though H 2 S levels have been shown to be elevated in observational human septic shock studies, there are no reports of using IV hydroxocobalamin in human septic shock. Human data for IV hydroxocobalamin are limited to single case reports and case series in patients with post‐CPB vasodilatory shock (Table ) …”

Section: The Interaction Between Vitamin B12 and Circulating Gasotranmentioning

confidence: 99%

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High‐Dose Vitamin B12 in Vasodilatory Shock: A Narrative Review

2019

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Vasodilatory shock, as observed in postoperative states and sepsis, is hallmarked by low systemic vascular resistance and low blood pressure compensated by increased cardiac output. Gasotransmitters, such as nitric oxide and hydrogen sulfide, are implicated in the development and perpetuation of vasodilatory shock. Established therapies do not target these physiologic drivers of vasodilation. Due to their nontoxic and pleotropic effects, micronutrients are being used as rescue therapy in postoperative vasoplegia and septic shock. Here, we outline the pathophysiology of vasodilatory shock, describe the rationale for vitamin B12 (hydroxocobalamin) in vasodilatory shock, and identify literature evaluating its use in vasoplegic states. (Nutr Clin Pract. 2019;34:514-520)

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Section: The Interaction Between Vitamin B12 and Circulating Gasotranmentioning

confidence: 99%

Section: The Interaction Between Vitamin B12 and Circulating Gasotranmentioning

confidence: 99%

High‐Dose Vitamin B12 in Vasodilatory Shock: A Narrative Review

2019

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“…Methylene blue, which competitively inhibits the activity of nitric oxide, has been established as an effective treatment for refractory post‐bypass vasoplegia in adults and has been used more recently with success in children . In the past few years, high‐dose hydroxycobalamin, another nitric oxide inhibitor, has shown promise in case reports as an effective treatment for refractory vasoplegia in children and adults …”

Section: Medical Treatment Of Hypotensionmentioning

confidence: 99%

“…31 In the past few years, high-dose hydroxycobalamin, another nitric oxide inhibitor, has shown promise in case reports as an effective treatment for refractory vasoplegia in children and adults. 32 In the setting of elevated PVR, inhaled nitric oxide (iNO) causes pulmonary vasodilation, thus decreasing RV afterload and improving LV filling and output. 33…”

Section: Post-bypassmentioning

confidence: 99%

Current perspectives on treatment of perioperative hemodynamic instability and hypotension

Joffe

Latham

Ross

2019

Pediatric Anesthesia

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Summary Overall, there are numerous causes of hypotension in the perioperative period. The approach to definitive treatment must be tailored to the child's unique anatomy and physiology, as well as the current factors presumed to be eliciting the hypotensive state. It is imperative to consider both routine and lesion‐specific etiologies to the current hypotensive episode. Lastly, when employing pharmacologic therapy for hypotension, there are often multiple combinations of medications that can reasonably be used to achieve the desired hemodynamic effects.

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“…An observed side effect of hydroxocobalamin is hypertension, which recently has led to its use for treatment of vasoplegic syndrome . Vasoplegic syndrome is a common complication in patients undergoing CPB and is characterized by significant hypotension, normal/high cardiac output, and low systemic vascular resistance . In addition to binding cyanide, hydroxocobalamin binds vasodilatory compounds hydrogen sulfide and carbon monoxide and affects nitric oxide metabolism, potentially explaining observed hypertension .…”

mentioning

confidence: 99%