Research Article
Volume 4 Issue 6 - 2020
The Effect of Using Vitamin C, Hydrocortisone and Thiamine Triple Therapy in the Treatment of Septic Shock - A Randomized Clinical Trial - Pilot Study
Reza Ronaghi1*, Kelly Fan1,2, Jordan Rees1, Patrick Baghdasaryan1, Jenny Tang1, Adrienne Quinn1, Samantha Spieling3, May Lee1 and Ahmet Baydur1
1Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Keck School of Medicine, University of Southern California, USA
2Scripps Health, La Jolla, CA, USA
3Scripps Whittier Diabetes Institute, Scripps Health, La Jolla, CA, USA
*Corresponding Author: Reza Ronaghi, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Keck School of Medicine, University of Southern California, USA.
Received: April 19, 2020; Published: May 25, 2020




Abstract

Introduction: Sepsis is a clinical syndrome with physiologic and biochemical derangements caused by a dysregulated inflammatory response to infection. A recent retrospective study demonstrated that vitamin C, hydrocortisone and thiamine in intensive care unit (ICU) patients with septic shock, when added to standard care, improved mortality and outcomes.

Methods: This prospective single-blinded study evaluated the effects of addition of triple therapy to standard ICU care on 28-day mortality in patients with septic shock defined as sepsis-induced hypotension requiring vasopressors with serum lactate level > 2 mmol/L. Patients were randomized to receive either standard ICU care (control) or standard care plus intravenous (IV) Vitamin C (1.5 gram every 6 hours) for 4 days or until ICU discharge, IV hydrocortisone (50 mg every 6 hours) for 7 days or until ICU discharge, and IV thiamine (200 mg every 12 hours) for 4 days or until ICU discharge.

Results: Analysis of 41 enrolled patients showed no significant difference at baseline between the two groups in terms of demographics or severity of septic shock. Triple therapy showed no effects on ICU length of stay, weaning from vasoactive drugs, clearance of lactic acid, preservation of renal function and weaning from ventilator support. The triple therapy group showed a trend towards increased mortality that did not reach statistical significance, but a low side-effect profile, indicating safety for use.

Interpretation: This prospective human study suggests triple therapy has limited use in the treatment of septic shock; larger studies should be pursued prior to widespread usage in septic shock.

Keywords: Intensive Care Unit (ICU); Vitamin C; Intravenous (IV); Hydrocortisone

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Citation: Reza Ronaghi., et al. “The Effect of Using Vitamin C, Hydrocortisone and Thiamine Triple Therapy in the Treatment of Septic Shock - A Randomized Clinical Trial - Pilot Study”. EC Emergency Medicine and Critical Care 4.6 (2020): 109-118.

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