History of scurvy and use of vitamin C in critical illness: A narrative review

Dresen, Ellen; Lee, Zheng‐Yii; Hill, Aileen; Notz, Quirin; Patel, Jayshil J.; Stoppe, Christian

doi:10.1002/ncp.10914

Cited by 31 publications

(23 citation statements)

References 73 publications

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“…In addition, patients who experience greater losses of water-soluble micronutrients, for example during extracorporeal circulation (e.g., with hemofiltration or extracorporeal membrane oxygenation or patients with significant exudation (large wound surface, thermal injury, open abdomen) may need a greater amount and parenteral administration of vitamin C when compared to other patients ( 88 ).…”

Section: Vitamin Cmentioning

confidence: 99%

An update of the effects of vitamins D and C in critical illness

Hill

Starchl²,

Dresen³

et al. 2023

Front. Med.

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Many critically ill patients are vitamin D and vitamin C deficient and the current international guidelines state that hypovitaminoses should be compensated. However, uncertainty about optimal dosage, timing and indication exists in clinical routine, mainly due to the conflicting evidence. This narrative review discusses both micronutrients with regards to pathophysiology, clinical evidence of benefits, potential risks, and guideline recommendations. Evidence generated from the most recent clinical trials are summarized and discussed. In addition, pragmatic tips for the application of these vitamins in the clinical routine are given. The supplementations of vitamin D and C represent cost-effective and simple interventions with excellent safety profiles. Regarding vitamin D, critically ill individuals require a loading dose to improve 25(OH)D levels within a few days, followed by a daily or weekly maintenance dose, usually higher doses than healthy individuals are needed. For vitamin C, dosages of 100–200 mg/d are recommended for patients receiving parenteral nutrition, but needs may be as high as 2–3 g/d in acutely ill patients.

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Section: Vitamin Cmentioning

confidence: 99%

An update of the effects of vitamins D and C in critical illness

Hill

Starchl²,

Dresen³

et al. 2023

Front. Med.

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“…Beyond acting as an essential nutrient, such high dose will exert a 'drug-like' effect to the body, this is known as pharmaconutrition. The mortality benefit observed may be due to the stronger effect of the anti-inflammation, immuneenhancing and wound healing functions, among others, exerted by the pharmaconutrition dose of Vitamin C [1,52]; however, the exact underlying mechanism remained to be investigated. On the other hand, pharmaconutrition is not without any risk, which have to be considered carefully.…”

Section: Subgroup and Sensitivity Analysesmentioning

confidence: 99%

Intravenous vitamin C monotherapy in critically ill patients: a systematic review and meta-analysis of randomized controlled trials with trial sequential analysis

Lee

Ortiz-Reyes

Lew

et al. 2023

Ann. Intensive Care

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Background A recent landmark randomized controlled trial (RCT) in septic patients demonstrated an increased risk of death and persistent organ dysfunction with intravenous Vitamin C (IVVC) monotherapy, which represents a disparate result from previous systematic reviews and meta-analyses (SRMA). We performed an updated SRMA of IVVC monotherapy to summarize and explore heterogeneity across current trials and conduct trial sequential analysis (TSA) to guard against type-I or type-II statistical errors. Methods RCTs evaluating IVVC in adult critically ill patients were included. Four databases were searched from inception to 22 June 2022 without language restrictions. The primary outcome was overall mortality. Random effect meta-analysis was performed to estimate the pooled risk ratio. TSA for mortality was performed using the DerSimonian–Laird random effect model, alpha 5%, beta 10%, and relative risk reduction (RRR) of 30%, 25%, and 20%. Results We included 16 RCTs (n = 2130). IVVC monotherapy is associated with significant reduction in overall mortality [risk ratio (RR) 0.73, 95% confidence interval (CI) 0.60–0.89; p = 0.002; I2 = 42%]. This finding is supported by TSA using RRR of 30% and 25%, and sensitivity analysis using fixed-effect meta-analysis. However, the certainty of our mortality finding was rated low using GRADE due to the serious risk of bias and inconsistency. In a priori subgroup analyses, we found no differences between single vs multicenter, higher (≥ 10,000 mg/day) vs lower dose and sepsis vs non-sepsis trials. Post-hoc, we found no differences in subgroup analysis of earlier (< 24 h) vs delayed treatment, longer (> 4 days) vs shorter treatment duration, and low vs other risk of bias studies. IVVC may have the greatest benefit in trials that enrolled patients above (i.e., > 37.5%; RR 0.65, 95% CI 0.54–0.79) vs below (i.e., ≤ 37.5%; RR 0.89, 95% CI 0.68–1.16) median control group mortality (test for subgroup differences: p = 0.06), and TSA supported this. Conclusions IVVC monotherapy may be associated with mortality benefits in critically ill patients, particularly in patients with a high risk of dying. Given the low certainty of evidence, this potentially life-saving therapy warrants further studies to identify the optimal timing, dosage, treatment duration, and patient population that will benefit most from IVVC monotherapy. PROSPERO Registration ID: CRD42022323880. Registered 7th May 2022.

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“…Auch PatientInnen mit größeren Verlusten an wasserlöslichen Mikronährstoffen, wie z. B. bei extrakorporaler Zirkulation (Hämofiltration oder extrakorporale Membranoxygenierung [ECMO]) oder größeren Mengen an Exsudat (Wundflächen, Verbrennung, Laparostoma), könnten von einer erhöhten Vitamin-C-Supplementierung profitieren [ 9 ].…”

Section: Supplementierung Mit Vitamin Cunclassified

Supplementierung von Vitamin C und D bei kritisch Kranken

Hill

Starchl²,

Dresen

et al. 2023

Med Klin Intensivmed Notfmed

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Der Supplementierung von Mikronährstoffen als Bestandteil der medizinischen Ernährungstherapie kritisch kranker PatientInnen auf der Intensivstation fand in den letzten Jahren zunehmend Beachtung, dennoch herrscht im klinischen Alltag oft Unklarheit über die optimale Supplementierungsstrategie, insbesondere welche Substanz in welcher Dosierung und zu welchem Zeitpunkt welchen bestimmten PatientInnengruppen verabreicht werden soll. Das Ziel dieses narrativen Reviews ist es daher, den aktuellen Kenntnisstand zu den beiden Mikronährstoffen Vitamin C und Vitamin D übersichtlich zusammenzufassen. Beide Vitamine werden in ihren physiologischen und pathophysiologischen Rollen vorgestellt, die kürzlich publizierten klinischen Studien werden diskutiert und die Empfehlungen der aktuellen Leitlinien zusammengefasst. Zusätzlich werden pragmatische Hinweise für die Anwendung im klinischen Alltag auf der Intensivstation gegeben.

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History of scurvy and use of vitamin C in critical illness: A narrative review

Cited by 31 publications

References 73 publications

An update of the effects of vitamins D and C in critical illness

An update of the effects of vitamins D and C in critical illness

Intravenous vitamin C monotherapy in critically ill patients: a systematic review and meta-analysis of randomized controlled trials with trial sequential analysis

Supplementierung von Vitamin C und D bei kritisch Kranken

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