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Open Access 01-12-2019 | Heart Surgery | Letter
Vitamin C administration in the critically ill: a summary of recent meta-analyses
Published in: Critical Care | Issue 1/2019
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Since 2018, there has been a dramatic upsurge in publications relating to the use of vitamin C in critically ill patients, particularly those suffering from sepsis [1]. This has primarily been in response to the well-publicized before-and-after study of Marik et al. [2], which indicated that intravenous administration of 6 g/day vitamin C (in combination with thiamine and hydrocortisone) could improve the outcomes of patients with sepsis, including decreasing mortality. Over the past year, seven meta-analyses assessing the effects of vitamin C administration in critically ill patients have been published, with four appearing in the past 4 months alone (see Table 1 summary).
Table 1
A summary of recent meta-analysis of vitamin C administration in critical care patients
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Publication details
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Title
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Selection criteria (PICO)
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Included studies
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Subgroup analysis
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Findings
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|---|---|---|---|---|---|
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Putzu et al. [3]
Crit Care Med
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The effect of vitamin C on clinical outcome in critically ill patients: A systematic review with meta-analysis of randomised controlled trials
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P—adult critically ill patients
I—vitC (any regimen)
C—placebo or no therapy
O—mortality, acute kidney injury, supraventricular arrhythmia, ventricular arrhythmia, stroke, ICU LOS, hospital LOS
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44 RCTs:
16 in ICU setting (n = 2857)
28 in cardiac surgery (n = 3598)
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Mixed ICU vs burns vs sepsis/septic shock vs acute pancreatitis
VitC alone vs enteral vitC vs IV vitC vs IV vitC > 5 g
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ICU patients:
X mortality
X acute kidney injury
X ICU or hospital LOS
Cardiac surgery:
↓ postoperative atrial fibrillation
↓ ICU and hospital LOS
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|
Wang et al. [4]
Ann Intensive Care
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Effects of different ascorbic acid doses on the mortality of critically ill patients: a meta-analysis
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P—critically ill patients
I—IV vitC (including co-administration of antioxidants)
C—placebo or no intervention
O—mortality, resuscitation fluid requirement, urine output, acute kidney injury, vasopressor requirement, duration of mechanical ventilation, ICU and/or hospital LOS
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12 RCT, quasi-RCT, observational (n = 1210)
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Low dose vs medium dose vs high dose
Burn vs sepsis vs others
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↓ mortality (doses of 3–10 g/day)
X morality (< 3 g/day or ≥ 10 g/day)
↓ duration of vasopressor support
↓ duration of mechanical ventilation
X acute kidney injury
X ICU or hospital LOS
X fluid requirement
X urine output
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|
Hemila and Chalker [5]
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Vitamin C can shorten the length of stay in the ICU: A meta-analysis
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P—ICU patients
I—vitC
C—placebo or none
O—ICU LOS, duration of mechanical ventilation
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18 controlled trials (n = 2004)
including 13 cardiac surgery
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IV vs oral
1–2 days ICU vs 3–5 days ICU
> 24 h ventilation vs < 24 h ventilation
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↓ ICU LOS
↓ duration of mechanical ventilation
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|
Langlois et al. [6]
JPEN
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Vitamin C supplementation in the critically ill: A systematic review and meta-analysis
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P—ICU patients
I—vitC (enteral or parenteral)
C—placebo or none
O—mortality, incident infections, ICU LOS, hospital LOS, duration of mechanical ventilation
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11 RCTs
9 RCTs with mortality (n = 1322)
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Low dose vs high dose
Combined therapy vs monotherapy
Oral/enteral vs parenteral
Non-septic vs septic
Higher-quality trials vs low-quality trials
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X mortality
↓ (trend) mortality (IV high dose vitC monotherapy)
X infections
X ICU or hospital LOS
X duration of mechanical ventilation
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|
Zhang and Jativa [7]
SAGE Open Med
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Vitamin C supplementation in the critically ill: A systematic review and meta-analysis
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P—critically ill adult patients
I—IV vitC
C—placebo or no intervention
O—mortality, duration of mechanical ventilation, duration of vasopressor support, fluid requirements, urine output
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4 RCTs and 1 retrospective (n = 142)
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X mortality
↓ need for vasopressor support
↓ duration of mechanical ventilation
↓ (trend) fluid requirements
↑ (trend) urine output
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|
|
Li
Crit Care [1]
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Evidence is stronger than you think: a meta-analysis of vitamin C use in patients with sepsis
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P—patients with sepsis
I—IV vitC
C—placebo or none
O—mortality, ICU LOS, vasopressor duration
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2 RCTs and 1 before-after
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↓ mortality
X ICU LOS
↓ vasopressor duration
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|
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Lin et al. [8]
Open J Intern Med
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Adjuvant administration of vitamin C improves mortality of patients with sepsis and septic shock: A systems review and meta-analysis
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P—patients with septic shock and severe sepsis
I—vitC
C—placebo
O—mortality
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4 RCTs and 2 retrospective studies (n = 109)
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RCT vs retrospective
High dose vs low dose
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X mortality
↓ mortality (doses of > 50 mg/kg/day)
X ICU LOS
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