Abstract
BackgroundCritically ill patients frequently suffer from vitamin C deficiency. Previous studies showed that high doses of vitamin C administration had conflicting results on clinical outcomes in patients with severe sepsis, burns, and trauma. Because of the high incidence and morbidity/mortality with severe pneumonia, we aimed to investigate the effect of administration of high dose vitamin C in critically ill patients with severe pneumonia.MethodsEighty critically ill patients with pneumonia were enrolled in this randomized double-blinded clinical trial. Patients with a CURB-65 score > 3, one major criterion, or ≥ 3 minor criteria were considered as severe pneumonia. Patients were randomly assigned to intervention or placebo groups receiving standard treatment plus 60 mg/kg/day vitamin C as a continuous infusion or normal saline in the same volume correspondingly for 96 h. Serum levels of vitamin C were noted at baseline and 48 h after vitamin C administration. Duration of mechanical ventilation, ICU length of stay, PaO2/FiO2, and mortality rate were noted for all patients till the 28th day. Any complications related to the vitamin C administration were recorded.ResultsDuration of mechanical ventilation and vasopressor use were significantly lower in the intervention group (p: < 0.001 and 0.003, respectively). Baseline levels of vitamin C in both groups did not have a significant difference but its levels increased in the intervention group and decreased in the control group during the study period. Mortality rate insignificantly decreased in the intervention group (p = 0.17). Three patients showed hypotension and tachycardia during the administration of vitamin C which was self-limited with decreasing the dose of vitamin C.Our results showed that the intravenous administration of a relatively high dose of vitamin C to critically ill patients with severe pneumonia was safe and could decrease the inflammation, duration of mechanical ventilation, and vasopressor use without any significant effect on mortality.Trial registration: IRCT registration number: IRCT20190312043030N1, Registration date: 2019-08-26, Seied Hadi Saghaleini.
Highlights
Ill patients frequently suffer from vitamin C deficiency
Plasma levels of vitamin C are usually decreased in critically ill patients with sepsis, burn, major surgeries, trauma, and any disease accompanied by immune dysfunction and inflammation [1]
Based on the high incidence of pneumonia in critically ill patients and its effect on mortality, it seems that the effects of vitamin C on respiratory infections are important at the level of fundamental concepts
Summary
Previous studies showed that high doses of vitamin C administration had conflicting results on clinical outcomes in patients with severe sepsis, burns, and trauma. Plasma levels of vitamin C are usually decreased in critically ill patients with sepsis, burn, major surgeries, trauma, and any disease accompanied by immune dysfunction and inflammation [1]. There are many published trials about the positive effect of combination therapy of high dose vitamin C, thiamin, and fludrocortisone in septic patients They showed that this combination which targeted multiple components of host response could synergistically restore the immune dysfunction; future studies showed different results regarding morbidity and mortality [3, 4]. Based on the safety profile and molecular characteristics of vitamin C in critically ill patients and the controversial results of the previous studies, we aimed to evaluate the effect of high dose intravenous administration of vitamin C on the mortality of critically ill patients
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