Restrictive fluid therapy and high-dose vitamin C in sepsis

Plummer, Mark P.; Bellomo, Rinaldo

doi:10.1038/s41581-022-00609-5

Cited by 4 publications

(4 citation statements)

References 10 publications

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Section: Discussionmentioning

confidence: 99%

“…[28] A potential explanation for the harmful effects of vitamin C in the LOVIT trial is that vitamin C was administered at a pH as low as 5.0, which is 3 to 4-fold higher than that used in previous RCTs. [29] Heterogeneity in the treatment effects of intravenous vitamin C may be due to a multitude of causes. Moreover, the effects of vitamin C may also be associated with certain conditions.…”

Section: Vitamin C and Clinical Outcomes In Patients With Sepsismentioning

confidence: 99%

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High-dose vitamin C improves norepinephrine level in patients with septic shock: A single-center, prospective, randomized controlled trial

Li,

Zhao,

Liu

et al. 2024

Medicine

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Background: The effects of vitamin C supplementation on patients with septic shock remain controversial. We aimed to evaluate the effects of different vitamin C dosages on norepinephrine (NE) synthesis in adult patients with septic shock. Methods: A total of 58 patients with septic shock admitted to our intensive care unit (ICU) between July 2021 and December 2022 were included. Patients were randomly divided into 3 groups: high-dose vitamin C (150 mg/kg/d, group A), low-dose vitamin C (50 mg/kg/d, group B), and placebo (group C). NE synthesis-related indicators (dopamine-β-hydroxylase [DβH], tyrosine hydroxylase [TH], tetrahydrobiopterin [BH4], and dopamine [DA]), plasma NE, and vitamin C levels were measured every 24 hours and analyzed. All-cause mortality within 28 days and other clinical outcomes (including Acute Physiology and Chronic Health Evaluation [APACHE], Sequential Organ Failure Assessment [SOFA], and Multiple-Organ Dysfunction Syndrome [MODS] scores) were compared. Results: Changes in TH, BH4, and DβH levels at 96 hours in groups A and B were greater than those in group C. These differences became more pronounced over the course of the intravenous vitamin C administration. Significant differences between groups A and C were detected at 96-hours TH, 72-hours BH4, 96-hours BH4, 96-hours DA, and DβH levels every 24 hours. The 96-hours TH, 96-hours BH4, and 48-hours DβH in group B were significantly higher than those in group C. The NE levels every 24 hours in groups A and B were higher than those in group C, group A and group C had a statistically significant difference. The 96-hours exogenous NE dosage in groups A and B was significantly lower than that in group C. No significant reductions in APACHE, SOFA, or MODS scores were observed in the vitamin C group, including the duration of ICU stay and mechanical ventilation. The 28-days mortality was lower in groups A and B than in group C (0%, 10%, and 16.67%, P = .187), but the difference was not significant. Conclusion: For patients with septic shock, treatment with vitamin C significantly increased TH, BH4, and DβH levels and reduced the exogenous NE dosage, but did not significantly improve clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Vitamin C and Clinical Outcomes In Patients With Sepsismentioning

confidence: 99%

High-dose vitamin C improves norepinephrine level in patients with septic shock: A single-center, prospective, randomized controlled trial

Li,

Zhao,

Liu

et al. 2024

Medicine

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“…This has previously resulted in patient harm [47,48]. Additionally, vitamin C is delivered with a pH as low as 5.0 which, in the setting of sepsis-induced buffering compromises, may cause harm [49 ▪ ]. Finally, steroids, given to most patients in the trial, may negatively impact vitamin C effectiveness as compared to vitamin C “monotherapy.”…”

Section: Sepsis: Possible Explanations For Signs Of Harm In Lovit And...mentioning

confidence: 99%

Vitamin C for all?

de Man,

Long,

Stoppe

2024

Current Opinion in Critical Care

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Purpose of review Vitamin C can be a potential adjunctive treatment option for critically ill individuals due to its pleiotropic effects as electron donor in many enzymatic reactions throughout the body. Recently, several important randomized controlled trials (RCTs) investigating vitamin C in critically ill patients have been published. Recent findings Two recent large RCTs administering high-dose vitamin C to patients with sepsis and COVID-19 showed signs of harm. Though performed at high standard, these trials had several limitations. Recent studies in cardiac surgery and burns showed decreased cardiac enzymes and improved clinical outcomes after cardiac surgery, and decreased fluid requirements, reduced wound healing time and in-hospital mortality after burns. Vitamin C may hold benefit in the management of other ischemia/reperfusion injury populations, including postcardiac arrest patients and after solid organ transplantation. Currently, covering basal vitamin C requirements during critical illness is recommended, though the exact dose remains to be determined. Summary Future work should address optimal vitamin C timing, since early versus late drug administration are likely distinct, and duration of therapy, where withdrawal-induced injury is possible. Additionally accurate assessment of body stores with determination of individual vitamin requirements is crucial to ascertain patient and subgroups most likely to benefit from vitamin C.

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“…Die Heterogenität der bisherigen Ergebnisse könnte ein Indikator dafür sein, dass bestimmte Subgruppen -beispielsweise Patienten mit besonders ausgeprägtem Vitamin-C-Mangel -von hochdosierter Vitamin-C-Gabe profitieren könnten [186]. Bis weitere Studien die Datengrundlage erweitern, unterstützt die aktuelle Evidenz bislang noch nicht die routinemäßige Anwendung von Vitamin C bei septischen Patienten [160,186,218].…”

Section: Vitamin Cunclassified

Immunmodulation durch Ernährung bei kritisch kranken Patienten

Hirschberger

Schmid²,

Kreth³

2023

Anaesthesiologie

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ZusammenfassungKritisch kranke Patienten leiden häufig unter einer komplexen und schwerwiegenden immunologischen Dysfunktion. Die Differenzierung und Funktion von Immunzellen werden maßgeblich durch metabolische Prozesse gesteuert. Neue immunonutritive Konzepte versuchen daher, die Immunfunktionen intensivmedizinischer Patienten über enterale und parenterale Ernährung positiv zu beeinflussen. Die vorliegende Übersichtsarbeit präsentiert kondensiert die verfügbare Evidenz zu den gängigen isolierten Supplementen (antioxidative Substanzen, Aminosäuren, essenzielle Fettsäuren) und die damit verbundenen Problematiken. Im zweiten Teil werden sich daraus ergebende neuartige und umfassendere Konzepte der Immunonutrition zur Beeinflussung des intestinalen Mikrobioms und zur Modulation der Makronährstoffkomposition vorgestellt. Die Immunonutrition des kritisch kranken Patienten hat enormes Potenzial und kann sich zukünftig zu einem wertvollen klinischen Tool zur Modulation des Immunmetabolismus intensivmedizinischer Patienten entwickeln.

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Restrictive fluid therapy and high-dose vitamin C in sepsis

Cited by 4 publications

References 10 publications

High-dose vitamin C improves norepinephrine level in patients with septic shock: A single-center, prospective, randomized controlled trial

High-dose vitamin C improves norepinephrine level in patients with septic shock: A single-center, prospective, randomized controlled trial

Vitamin C for all?

Immunmodulation durch Ernährung bei kritisch kranken Patienten

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