Vasoplegia is generally defined as prolonged vasodilation due to a pathological decrease in systemic vascular resistance, which causes persistent hypotension even in the setting of normal or increased cardiac output.

Vasoplegia is one of the main physiological dysfunctions in shock, and managing vasoplegia along with maintaining hemodynamic stability are primary treatment goals for patients with shock.

The evidence for the use of hydroxocobalamin for treatment-resistant vasoplegia is inconsistent.

Some studies reported rapid, short-lived increases in MAP and decreased vasopressor requirements while others failed to find treatment benefit.

Larger, randomized controlled studies with relevant clinical outcomes are needed to improve the evidence supporting the use of hydroxocobalamin.

Until more data is available, hydroxocobalamin use for shock-associated refractory vasoplegia should be reserved for treatment-refractory, carefully selected patients.

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