{"id":22964,"date":"2022-11-24T05:15:00","date_gmt":"2022-11-23T21:15:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=22964"},"modified":"2022-11-24T05:47:45","modified_gmt":"2022-11-23T21:47:45","slug":"chest%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e5%a4%a7%e5%89%82%e9%87%8f%e9%9d%99%e8%84%89%e7%bb%b4%e7%94%9f%e7%b4%a0b12%e6%b2%bb%e7%96%97%e6%84%9f%e6%9f%93%e6%80%a7%e4%bc%91%e5%85%8b","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=22964","title":{"rendered":"[Chest\u53d1\u8868\u8bba\u6587]\uff1a\u5927\u5242\u91cf\u9759\u8109\u7ef4\u751f\u7d20B12\u6cbb\u7597\u611f\u67d3\u6027\u4f11\u514b"},"content":{"rendered":"\n

ORIGINAL RESEARCH|ARTICLES IN PRESS<\/a><\/p>\n\n\n\n

High-Dose Intravenous Hydroxocobalamin (Vitamin B12) in Septic Shock: A Double-Blind, Allocation-Concealed, Placebo-Controlled Single-Center Pilot Randomized Controlled Trial (The IV-HOCSS Trial)<\/h1>\n\n\n\n

Jayshil J. Patel, Rodney Willoughby, Jennifer Peterson, et al<\/h3>\n\n\n\n

Chest Published:September 26, 2022<\/h3>\n\n\n\n

DOI:https:\/\/doi.org\/10.1016\/j.chest.2022.09.021<\/a><\/h3>\n\n\n\n

Abstract<\/h2>\n\n\n\n

Background<\/h3>\n\n\n\n

Elevated hydrogen sulfide (H2<\/sub>S) contributes to vasodilatation and hypotension in septic shock and traditional therapies do not target this pathophysiologic mechanism. High-dose intravenous (IV) hydroxocobalamin (IV-HOC) scavenges and prevents H2<\/sub>S formation, which may restore vascular tone and accentuate recovery. No experimental human studies have tested IV-HOC in adults with septic shock.<\/p>\n\n\n\n

Research Question<\/h3>\n\n\n\n

In adults with septic shock, is comparing IV-HOC to placebo feasible?<\/p>\n\n\n\n

Study Design and Methods<\/h3>\n\n\n\n

We conducted a phase 2 single-center, double-blind, allocation-concealed, placebo controlled, parallel group pilot RCT comparing IV-HOC with placebo in critically ill adults with septic shock. Patients meeting Sepsis-3 criteria were randomized 1:1 to receive a single 5-gram dose of IV-HOC or equivalent volume 0.9% saline solution as placebo. The primary outcome was study feasibility (enrollment rate, clinical and laboratory compliance rate, and contamination rate). Secondary outcomes included between-group differences in pre- and post-infusion plasma H2<\/sub>S concentrations and vasopressor dose.<\/p>\n\n\n\n

Results<\/h3>\n\n\n\n

Twenty patients were enrolled over 19 months, establishing an enrollment rate of 1.05 patients per month. Protocol adherence rates were 100% with zero contamination. In the IV-HOC group, compared to placebo, there was a greater reduction in vasopressor dose between randomization and post-infusion (-36% vs 4%, p<0.001) and randomization and 3-hours-post-infusion (-28% vs 10%, p=0.019). In the IV-HOC group, the plasma H2<\/sub>S level was reduced over 45 minutes by -0.80 \u03bcM (\u00b11.73), as compared to -0.21 \u03bcM (\u00b10.64) in the placebo group (p=0.3).<\/p>\n\n\n\n

Interpretation<\/h3>\n\n\n\n

Our pilot trial established favorable feasibility metrics. Consistent with the proposed mechanism of benefit, IV-HOC, compared to placebo, was associated with reduced vasopressor dose and H2<\/sub>S levels at all time-points and without serious adverse events. These data provide first proof-of-concept for feasibility of delivering IV-HOC in septic shock.<\/p>\n","protected":false},"excerpt":{"rendered":"

ORIGINAL RESEARCH|ARTICLES IN PRESS High-Dose Intraveno […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/22964"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=22964"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/22964\/revisions"}],"predecessor-version":[{"id":22965,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/22964\/revisions\/22965"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=22964"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=22964"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=22964"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}