Use of Artificial Intelligence to Detect Refractory Vasoplegic and Septic Shock when Hydroxocobalamin Used as a Rescue Therapy

Hydroxocobalamin (HCB), which helps remove nitric oxide (NO) and hydrogen sulfide (H2S) from the body, is useful as a treatment option in severe cases of vasodilatory shock that do not respond to usual treatments. This includes situations such as sepsis, after heart-lung machine use, during liver transplants, and from certain drugs. This review examines its proposed mechanisms, emerging clinical applications, dosing approaches, safety profile, and comparison with agents such as methylene blue and angiotensin II. By binding excess NO/H2S and inhibiting inducible NO synthase and guanylate cyclase, it rapidly improves mean arterial pressure and reduces vasopressor dependence, often within hours. Small retrospective series report consistent hemodynamic rescue with mainly benign, transient side effects (e.g., chromaturia). Although encouraging, all current evidence is observational. To determine its function, ideal time, and dosage in critical care, randomized controlled trials are required.