VITAMINS

Effect of Vitamin C, Hydrocortisone, and Thiamine vs Hydrocortisone Alone on Time Alive and Free of Vasopressor Support Among Patients With Septic Shock
Fujii. JAMA 2020; Published online January 17, 2020. doi:10.1001/jama.2019.22176

Clinical Question
-  Does treatment with vitamin C, hydrocortisone, and thiamine lead to a more rapid resolution of septic shock compared with hydrocortisone alone?

N = 216, 10 ICUs in Australia & NZ & Brazil

Authors’ Conclusions
-  In patients with septic shock, treatment with intravenous vitamin C, hydrocortisone, and thiamine, compared with intravenous hydrocortisone alone, did not significantly improve the duration of time alive and free of vasopressor administration over 7 days. The finding suggests that treatment with intravenous vitamin C, hydrocortisone, and thiamine does not lead to a more rapid resolution of septic shock compared with intravenous hydrocortisone alone

The Bottom Line
-  I will continue my current practice which is not to use the HAT (hydrocortisone, ascorbic acid and thiamine) protocol for treating septic shock
-  Further studies looking at timing of treatment intervention may be helpful although the unintended consequences of diverting funding from other research opportunities in sepsis and other diseases must also be considered. Completion of several existing trials will hopefully provide the information we need
-  Whilst we continue our search for the elusive magic bullet for sepsis we must not lose focus on interventions that we know are life saving: the right antibiotics given early, together with antimicrobial stewardship, source control, and optimal physiological support