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Critical Care
Published in: Critical Care 1/2018

Open Access 01-12-2018 | Review

Ascorbic acid, corticosteroids, and thiamine in sepsis: a review of the biologic rationale and the present state of clinical evaluation

Authors: Ari Moskowitz, Lars W. Andersen, David T. Huang, Katherine M. Berg, Anne V. Grossestreuer, Paul E. Marik, Robert L. Sherwin, Peter C. Hou, Lance B. Becker, Michael N. Cocchi, Pratik Doshi, Jonathan Gong, Ayan Sen, Michael W. Donnino

Published in: Critical Care | Issue 1/2018

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Abstract

The combination of thiamine, ascorbic acid, and hydrocortisone has recently emerged as a potential adjunctive therapy to antibiotics, infectious source control, and supportive care for patients with sepsis and septic shock. In the present manuscript, we provide a comprehensive review of the pathophysiologic basis and supporting research for each element of the thiamine, ascorbic acid, and hydrocortisone drug combination in sepsis. In addition, we describe potential areas of synergy between these therapies and discuss the strengths/weaknesses of the two studies to date which have evaluated the drug combination in patients with severe infection. Finally, we describe the current state of current clinical practice as it relates to the thiamine, ascorbic acid, and hydrocortisone combination and present an overview of the randomized, placebo-controlled, multi-center Ascorbic acid, Corticosteroids, and Thiamine in Sepsis (ACTS) trial and other planned/ongoing randomized clinical trials.
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Metadata
Title
Ascorbic acid, corticosteroids, and thiamine in sepsis: a review of the biologic rationale and the present state of clinical evaluation
Authors
Ari Moskowitz
Lars W. Andersen
David T. Huang
Katherine M. Berg
Anne V. Grossestreuer
Paul E. Marik
Robert L. Sherwin
Peter C. Hou
Lance B. Becker
Michael N. Cocchi
Pratik Doshi
Jonathan Gong
Ayan Sen
Michael W. Donnino
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2018
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-018-2217-4

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