Sharma Sachit, Paneru Hem R, Shrestha Gentle S, Shrestha Pramesh S, Acharya Subhash P
Department of Critical Care Medicine, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Bagmati, Nepal.
Indian J Crit Care Med. 2024 Dec;28(12):1147-1152. doi: 10.5005/jp-journals-10071-24852. Epub 2024 Nov 30.
Glucocorticoids, vitamin C and thiamine have important biological effects in patients with sepsis and septic shock. Multiple studies have demonstrated the beneficial role of a combination therapy of vitamin C, hydrocortisone and thiamine in patients with sepsis and septic shock in terms of mortality reduction, and increase in the number of days free of ventilators and vasopressors.
Patients who had septic shock were assessed for eligibility after intensive care unit (ICU) admission. After randomization, the treatment group received a combination of vitamin C, thiamine and hydrocortisone for a duration of 96 hours (16 doses) and the control group received hydrocortisone for a duration till the patient was on vasopressors. The primary outcome assessed was ICU mortality, and the key secondary outcome was the duration free of vasopressor administration at the end of 7 days.
A total of 86 patients were included in the study. Seventy percent of patients in the control group and 58 percent in the intervention group died during ICU stay. None of the primary and secondary outcomes were statistically significant.
The use of a combination of vitamin C, hydrocortisone and thiamine has no added benefits over the use of hydrocortisone alone in patients with septic shock.
The results of this clinical trial shows that the use of a combination of vitamin C, hydrocortisone and thiamine in patients with septic shock is not useful and should not be a routine practice in critically ill septic patients.
Sharma S, Paneru HR, Shrestha GS, Shrestha PS, Acharya SP. Evaluation of the Effects of a Combination of Vitamin C, Thiamine and Hydrocortisone vs Hydrocortisone Alone on ICU Outcome in Patients with Septic Shock: A Randomized Controlled Trial. Indian J Crit Care Med 2024;28(12):1147-1152.
糖皮质激素、维生素C和硫胺素在脓毒症和脓毒性休克患者中具有重要的生物学效应。多项研究表明，维生素C、氢化可的松和硫胺素联合治疗在降低脓毒症和脓毒性休克患者死亡率、增加无呼吸机和血管升压药天数方面具有有益作用。
脓毒性休克患者在入住重症监护病房（ICU）后评估其入选资格。随机分组后，治疗组接受维生素C、硫胺素和氢化可的松联合治疗96小时（16剂），对照组接受氢化可的松治疗，持续至患者使用血管升压药。评估的主要结局是ICU死亡率，关键次要结局是7天结束时无血管升压药使用的持续时间。
本研究共纳入86例患者。对照组70%的患者和干预组58%的患者在ICU住院期间死亡。主要和次要结局均无统计学意义。
对于脓毒性休克患者，维生素C、氢化可的松和硫胺素联合使用相较于单独使用氢化可的松并无额外益处。
该临床试验结果表明，脓毒性休克患者使用维生素C、氢化可的松和硫胺素联合治疗并无作用，不应成为重症脓毒症患者的常规治疗方法。
夏尔马S，帕内鲁HR，什雷斯塔GS，什雷斯塔PS，阿查里亚SP。维生素C、硫胺素和氢化可的松联合与单独使用氢化可的松对脓毒性休克患者ICU结局影响的评估：一项随机对照试验。《印度重症监护医学杂志》2024；28（12）：1147 - 1152。
