Pharmacokinetic data support 6-hourly dosing of intravenous vitamin C to critically ill patients with septic shock.

2020 ◽  
Vol 22 (2) ◽  
pp. 174-174
Keyword(s):  
Septic Shock ◽  
Vitamin C ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Pharmacokinetic Data ◽  
Icu Admission ◽  
Data Support ◽  
Intravenous Vitamin

Hudson EP, Collie JT, Fujii T, et al. Pharmacokinetic data support 6-hourly dosing of intravenous vitamin C to critically ill patients with septic shock. Crit Care Resusc 2019; 21: 236-42. In this article, on page 238, Table 1 contained an error. Where it says “Time from randomisation to first dose of vitamin C (hours), median (IQR)”, it should read “Time from ICU admission to first dose of vitamin C (hours), median (IQR)”.

scholarly journals Colistin-Resistant Acinetobacter Baumannii Bacteremia: A Serious Threat for Critically Ill Patients

2020 ◽  
Vol 8 (2) ◽  
pp. 287 ◽  
Author(s):  
Georgios Papathanakos ◽  
Ioannis Andrianopoulos ◽  
Athanasios Papathanasiou ◽  
Efthalia Priavali ◽  
Despoina Koulenti ◽  
...  
Keyword(s):  
Septic Shock ◽  
Acinetobacter Baumannii ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Clinical Problem ◽  
Hospital Infections ◽  
Colistin Resistance ◽  
Icu Patients ◽  
Icu Admission ◽  
Comorbidity Index

The prevalence of acinetobacter baumannii (AB) as a cause of hospital infections has been rising. Unfortunately, emerging colistin resistance limits therapeutic options and affects the outcome. The aim of the study was to confirm our clinically-driven hypothesis that intensive care unit (ICU) patients with AB resistant-to-colistin (ABCoR) bloodstream infection (BSI) develop fulminant septic shock and die. We conducted a 28-month retrospective observational study including all patients developing AB infection on ICU admission or during ICU stay. From 622 screened patients, 31 patients with BSI sepsis were identified. Thirteen (41.9%) patients had ABCoR BSI and 18/31 (58.1%) had colistin-susceptible (ABCoS) BSI. All ABCoR BSI patients died; of them, 69% (9/13) presented with fulminant septic shock and died within the first 3 days from its onset. ABCoR BSI patients compared to ABCoS BSI patients had higher mortality (100% vs. 50%, respectively (p = 0.001)), died sooner (p = 0.006), had lower pH (p = 0.004) and higher lactate on ICU admission (p = 0.0001), and had higher APACHE II (p = 0.01) and Charlson Comorbidity Index scores (p = 0.044). In conclusion, we documented that critically ill patients with ABCoR BSI exhibit fulminant septic shock with excessive mortality. Our results highlight the emerging clinical problem of AB colistin resistance among ICU patients.

scholarly journals Use of Intravenous Vitamin C in Critically Ill Patients With COVID-19 Infection

2021 ◽  
pp. 089719002110150
Author(s):  
Matthew Li ◽  
Tsung Han Ching ◽  
Christopher Hipple ◽  
Ricardo Lopez ◽  
Asad Sahibzada ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Vitamin C ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Primary Objective ◽  
Primary Study ◽  
Protective Effects ◽  
Icu Length Of Stay ◽  
Intravenous Vitamin

Introduction The pathophysiology for Coronavirus Disease 2019 (COVID-19) infection is characterized by cytokine oxidative stress and endothelial dysfunction. Intravenous (IV) vitamin C has been utilized as adjuvant therapy in critically ill patients with sepsis for its protective effects against reactive oxygen species and immunomodulatory effects. The primary objective of this study was to evaluate the effects of IV vitamin C in critically ill patients with COVID-19 infection. Methods Retrospective observational cohort study with propensity score matching of intensive care unit (ICU) patients who received 1.5 grams IV vitamin C every 6 hours for up to 4 days for COVID-19 infection. The primary study outcome was in-hospital mortality. Secondary outcomes included vasopressor requirements in norepinephrine equivalents, ICU length of stay, and change in Sequential Organ Failure Assessment (SOFA) score. Results Eight patients received IV vitamin C and were matched to 24 patients. Patients in the IV vitamin C group had higher rates of hospital mortality [7 (88%) vs. 19 (79%), P = 0.049]. There was no difference in the daily vasopressor requirement in the treatment group or between the 2 groups. The mean SOFA scores post-treatment was higher in the IV vitamin C group (12.4 ± 2.8 vs. 8.1 ± 3.5, P < 0.005). There was no difference in ICU length of stay between the treatment and control groups. Conclusion Adjunctive IV vitamin C for the management of COVID-19 infection in critically ill patients may not decrease the incidence of mortality, vasopressor requirements, SOFA scores, or ventilator settings.

scholarly journals Association between phosphate disturbances and mortality among critically ill patients with sepsis or septic shock

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Shmeylan A. Al Harbi ◽  
Hasan M. Al-Dorzi ◽  
Albatool M. Al Meshari ◽  
Hani Tamim ◽  
Sheryl Ann I. Abdukahil ◽  
...  
Keyword(s):  
Septic Shock ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Retrospective Cohort ◽  
Clinical Characteristics ◽  
Serum Phosphate ◽  
The Other ◽  
Icu Admission ◽  
Surgical Icus

Abstract Objective The aim of this study is to examine the association of hypophosphatemia and hyperphosphatemia on the first day of ICU admission with mortality in septic critically ill patients. Methods In this retrospective cohort study, all adult patients who were admitted to the medical-surgical ICUs between 2014 and 2017 with sepsis or septic shock were categorized as having hypophosphatemia, normophosphatemia and hyperphosphatemia based on day 1 serum phosphate values. We compared the clinical characteristics and outcomes between the three groups. We used multivariate analysis to examine the association of hypophosphatemia and hyperphosphatemia with these outcomes. Results Of the 1422 patients enrolled in the study, 188 (13%) had hypophosphatemia, 865 (61%) normophosphatemia and 369 (26%) had hyperphosphatemia. The patients in the hyperphosphatemia group had significantly lower GCS, higher APACHE II scores, higher serum creatinine, increased use of vasopressors, and required more mechanical ventilation with lower PaO2/FiO2 ratio compared with the other two groups. In addition, the hyperphosphatemia group showed significantly higher ICU and hospital mortality in comparison with the other two groups. Conclusion Hyperphosphatemia and not hypophosphatemia on the first ICU admission day was associated with an increase in the ICU and hospital mortality in septic critically ill patients.

scholarly journals Effects of a High Dose of Vitamin C along with Thiamine in Critically-ill Patients with Septic Shock: A Preliminary Study

2019 ◽  
pp. 1-7
Author(s):  
Hasanali Karimpour ◽  
Alireza Bahrami ◽  
Shila Amini ◽  
Mansour Rezaei ◽  
Javad Amini-Saman ◽  
...  
Keyword(s):  
Septic Shock ◽  
Vitamin C ◽  
Critically Ill ◽  
Sofa Score ◽  
Critically Ill Patients ◽  
Lactate Concentration ◽  
Intervention Group ◽  
Treatment Modalities ◽  
Control Group ◽  
High Dose

Septic shock may occur in critically ill patients and despite antimicrobial treatment, it is associated with a high mortality rate. It is reasonable to look for new treatment modalities that might improve outcome. This is a randomized, double-blind control trial aiming at critically-ill septic patients in a tertiary hospital. Patients with quick sofa score of 2 and with organ dysfunction were included in this study. The intervention group received high doses of vitamin C at a dose of 50 mg/kg/four times daily along with thiamine at a dose of 200 mg/ twice daily) and the control group received normal saline for four days. The dose of vasopressors, procalcitonin and lactate clearance, and mean sequential organ failure assessment (SOFA) score were examined in the two groups. Patients were followed for 28 days. One hundred patients were allocated into two equal groups, and there was no difference between the two groups regarding baseline characteristics. Mean lactate concentration, SOFA score, days of antimicrobial therapy, and mortality at 28 days were similar between them. However, the mean procalcitonin concentration, and mean vasopressor treatment hours were significantly lower in the intervention group (p<0.05). Although Days of ICU stay were lower in the intervention group, It did not reach statistical significance. The results of this study showed that treatment with high dose vitamin C Reduces the vasopressor requirement without any effects on other parameters. Further studies with larger sample size are required for more generalizable results.

Impact of Ursodeoxycholic Acid in Critically Ill Patients With Sepsis: A Retrospective Study

2022 ◽  
pp. 089719002110383
Author(s):  
Khalid Al Sulaiman ◽  
Abdullah Kharbosh ◽  
Khalid Bin Salah ◽  
Thamer Alsulaiman ◽  
Norah Al Andas ◽  
...  
Keyword(s):  
Septic Shock ◽  
Retrospective Study ◽  
Ursodeoxycholic Acid ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Severity Of Illness ◽  
Adult Patients ◽  
P Value ◽  
Icu Admission ◽  
Medical City

Background: Using ursodeoxycholic acid (UDCA) in critically ill patients as adjunctive therapy for sepsis/septic shock in neonates and children is controversial, while it has not been extensively investigated in adults. This study aims to assess the effect of UDCA use on the early resolution of sepsis/septic shock in critically ill adult patients. Method: A retrospective study of critically ill adult patients in the intensive care unit (ICU) admitted with sepsis/septic shock at King Abdulaziz Medical City. Based on their usage of UDCA, patients were categorized into two groups. A total of 88 patients were included for analysis after matching, based on severity of illness scores within 24-hours of ICU admission. The primary outcome was to assess the effect of UDCA on the severity and resolution of shock at day three of ICU admission. The secondary outcomes were 30-day in-hospital mortality, mechanical ventilation (MV) duration, and ICU length of stay (LOS). Results: Out of the 88 patients matched, 44 patients (50%) received UDCA during the study period. Using UDCA was neither associated with improvement in Sequential Organ Failure Assessment (SOFA) score ( p-value: 0.32), inotropes/vasopressors requirement ( p-value: 0.79), Glasgow Coma Scale (GCS) ( p-value: 0.59) nor total bilirubin levels ( p-value: 0.79) at day three compared with the control. There was a significant association between using UDCA and improvement in PaO2/FiO2 ratio ( p-value: 0.01) and early extubation at day three ( p-value: 0.04). Conclusion: Using UDCA in critically ill patients with sepsis/septic shock was not associated with improvement in shock severity and resolution. However, patients who received UDCA were more likely to be extubated and not require MV on day three of ICU admission.

scholarly journals Effect of vitamin C in critically ill patients with sepsis and septic shock: A meta-analysis

2021 ◽  
Vol 104 (1) ◽  
pp. 003685042199817
Author(s):  
Fang Feng ◽  
Huyong Yang ◽  
Weiwei Yang ◽  
Min Li ◽  
Xueni Chang ◽  
...  
Keyword(s):  
Septic Shock ◽  
Length Of Stay ◽  
Vitamin C ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Control Group ◽  
Icu Length Of Stay ◽  
Sepsis And Septic Shock

The objective of this study was to investigate the efficacy of vitamin C in patients experiencing sepsis and septic shock. The PubMed, Embase and Cochrane Library databases were searched for randomized controlled trials (RCTs) about vitamin C treatments for critically ill patients suffering from sepsis and septic shock from inception until December 31, 2019. The primary outcome was mortality, and the secondary outcomes were the ICU length of stay and the dose of vasopressors. A meta-analysis of nine RCTs with a total of 584 patients (301 in the intervention group and 283 in the control group) was conducted. There were significant differences between the vitamin C group and the control group in 28-day mortality (fixed effects OR = 0.60 95% CI [0.42, 0.85], p = 0.004) and in the dose of vasopressors (SMD = −0.88 95% CI [−1.48, −0.29], p = 0.003); however, the ICU length of stay was the same between the two groups (SMD  = −0.33 95% CI [−0.87, 0.20] p = 0.23). This meta-analysis demonstrated that the use of vitamin C (compared with placebo) led to a reduction in ICU mortality and a reduction in the dose of vasopressors in patients with septic shock. However, the ICU length of stay was not significantly different between the two groups. Therefore, multicentre and high-quality RCTs are needed to further clarify the safety and effectiveness of vitamin C among patients with sepsis and septic shock.

scholarly journals Association Between Phosphate Disturbances and Mortality Among Critically Ill Patients With Sepsis or Septic Shock

2021 ◽  
Author(s):  
Shmeylan Al Harbi ◽  
Hasan Al-Dorzi ◽  
Albatool Al Meshari ◽  
Hani Tamim ◽  
Sheryl Ann Abdukahil ◽  
...  
Keyword(s):  
Septic Shock ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Retrospective Cohort ◽  
Serum Phosphate ◽  
The Other ◽  
Icu Mortality ◽  
Icu Admission ◽  
Surgical Icus

Abstract Objective: The aim of this study is to examine the association of hypophosphatemia and hyperphosphatemia on the first day of ICU admission with mortality in septic critically ill patients. Methods: In this retrospective cohort study, all adult patients who were admitted to medical-surgical ICUs between 2014 and 2017 with sepsis or septic shock were categorized as having hypophosphatemia, hyperphosphatemia or based on day 1 serum phosphate values. We compared the clinical characteristics and outcomes between the three groups. We used multivariate analysis to examine the association of hypophosphatemia and hyperphosphatemia with these outcomes.Results: Of the 1422 patients enrolled in the study, 188 (13%) had hypophosphatemia, 865 (61%) normophosphatemia and 369 (26%) had hyperphosphatemia. Among the three groups, the patients in the hyperphosphatemia group had significantly lower GCS, higher APACHE II scores, higher serum creatinine, increased use of vasopressors, and required mechanical ventilation with lower PaO2/FiO2 ratio compared with the other two groups. In addition, hyperphosphatemia group also showed significantly higher ICU mortality and hospital mortality in comparison to the other two groups. Conclusion: Hyperphosphatemia and not hypophosphatemia on the first ICU admission day was associated with an increase in the ICU and hospital mortality in septic critically ill patients.

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