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Clinical Impact of Supplementation of Vitamins B1 and C on Patients with Sepsis-Related Acute Respiratory Distress Syndrome.
Yoo, JW, Kim, RB, Ju, S, Lee, SJ, Cho, YJ, Jeong, YY, Lee, JD, Kim, HC
Tuberculosis and respiratory diseases. 2020;83(3):248-254
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Acute respiratory distress syndrome (ARDS) is a life-threatening condition that commonly develops in patients with sepsis. Patients with ARDS require admission to intensive care and invasive mechanical ventilation. Vitamin B1 and C deficiencies have been reported in critically ill patients with sepsis. Vitamin B1 is involved in aerobic metabolism, and vitamin C has anti-inflammatory and anti-oxidative effects. The aim of this Korean retrospective cohort study was to evaluate the clinical impact of vitamin B1 and C supplementation in patients with sepsis-related ARDS. Patients with ARDS requiring invasive mechanical ventilation, admitted to an intensive care unit (ICU) were included in this study. Clinical outcomes were compared between patients administered with vitamin B1 (200 mg/day) and C (2 g/day) between June 2018-May 2019 (the supplementation group) and those who did not receive vitamin B1 and C administration between June 2017-May 2018 (the control group). Seventy-nine patients were included. Thirty-three patients received vitamin B1 and C, and 46 patients did not. There were no significant differences in the number of deaths between the patients who received vitamin B1 and C and those who did not. The mean number of days not requiring ICU admission or ventilation was greater in patients supplemented with vitamin B1 and C than that in the control patients, but the difference was not statistically significant. Steroid administration was more frequent in patients receiving vitamin B1 and C supplementation than in those without it. The authors concluded that Vitamin B1 and C supplementation at the doses used in this study did not reduce the death rates in ARDS patients.
Abstract
BACKGROUND Although few studies have reported improved clinical outcomes with the administration of vitamin B1 and C in critically ill patients with septic shock or severe pneumonia, its clinical impact on patients with sepsis-related acute respiratory distress syndrome (ARDS) remains unclear. The purpose of this study was to evaluate the association with vitamin B and C supplementation and clinical outcomes in patients with ARDS. METHODS Patients with ARDS requiring invasive mechanical ventilation, admitted to the medical intensive care unit (ICU) were included in this study. Clinical outcomes were compared between patients administered with vitamin B1 (200 mg/day) and C (2 g/day) June 2018-May 2019 (the supplementation group) and those who did not receive vitamin B1 and C administration June 2017-May 2018 (the control group). RESULTS Seventy-nine patients were included. Thirty-three patients received vitamin B1 and C whereas 46 patients did not. Steroid administration was more frequent in patients receiving vitamin B1 and C supplementation than in those without it. There were no significant differences in the mortality between the patients who received vitamin B1 and C and those who did not. There were not significant differences in ventilator and ICU-free days between each of the 21 matched patients. CONCLUSION Vitamin B1 and C supplementation was not associated with reduced mortality rates, and ventilator and ICU-free days in patients with sepsis-related ARDS requiring invasive mechanical ventilation.
2.
Vitamin C Can Shorten the Length of Stay in the ICU: A Meta-Analysis.
Hemilä, H, Chalker, E
Nutrients. 2019;11(4)
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For centuries, Vitamin C has been known as an important part of human health. Initially, deficiency was associated with scurvy, however subsequent research has found links between administration of Vitamin C and a number of conditions, including lowering blood pressure, decreasing blood glucose levels in Type 2 diabetes and shortening the duration of the common cold. This meta-analysis of 18 controlled trials examined the effect of Vitamin C on the length of ICU stay or the duration of mechanical ventilation. Doses varied from 1-3g daily orally and 0.5-110g daily intravenously and from 1-4 days in duration. The authors found that in 12 of the trials (1766 patients), Vitamin C shortened the length of ICU stay by 8%. 6 trials reported that Vitamin C shortened the length of mechanical ventilation by 8%. Given the significant price difference between Vitamin C supplementation and ICU stay, the authors suggest that further research is justified on the basis of these findings.
Abstract
A number of controlled trials have previously found that in some contexts, vitamin C can have beneficial effects on blood pressure, infections, bronchoconstriction, atrial fibrillation, and acute kidney injury. However, the practical significance of these effects is not clear. The purpose of this meta-analysis was to evaluate whether vitamin C has an effect on the practical outcomes: length of stay in the intensive care unit (ICU) and duration of mechanical ventilation. We identified 18 relevant controlled trials with a total of 2004 patients, 13 of which investigated patients undergoing elective cardiac surgery. We carried out the meta-analysis using the inverse variance, fixed effect options, using the ratio of means scale. In 12 trials with 1766 patients, vitamin C reduced the length of ICU stay on average by 7.8% (95% CI: 4.2% to 11.2%; p = 0.00003). In six trials, orally administered vitamin C in doses of 1⁻3 g/day (weighted mean 2.0 g/day) reduced the length of ICU stay by 8.6% (p = 0.003). In three trials in which patients needed mechanical ventilation for over 24 hours, vitamin C shortened the duration of mechanical ventilation by 18.2% (95% CI 7.7% to 27%; p = 0.001). Given the insignificant cost of vitamin C, even an 8% reduction in ICU stay is worth exploring. The effects of vitamin C on ICU patients should be investigated in more detail.