ABSTRACT
BACKGROUND: Critically ill patients frequently suffer from vitamin C deficiency. Previous studies showed that high doses of vitamin C administration had conflicting results on clinical outcomes in patients with severe sepsis, burns, and trauma. Because of the high incidence and morbidity/mortality with severe pneumonia, we aimed to investigate the effect of administration of high dose vitamin C in critically ill patients with severe pneumonia. METHODS: Eighty critically ill patients with pneumonia were enrolled in this randomized double-blinded clinical trial. Patients with a CURB-65 score > 3, one major criterion, or ≥ 3 minor criteria were considered as severe pneumonia. Patients were randomly assigned to intervention or placebo groups receiving standard treatment plus 60 mg/kg/day vitamin C as a continuous infusion or normal saline in the same volume correspondingly for 96 h. Serum levels of vitamin C were noted at baseline and 48 h after vitamin C administration. Duration of mechanical ventilation, ICU length of stay, PaO2/FiO2, and mortality rate were noted for all patients till the 28th day. Any complications related to the vitamin C administration were recorded. RESULTS: Duration of mechanical ventilation and vasopressor use were significantly lower in the intervention group (p: < 0.001 and 0.003, respectively). Baseline levels of vitamin C in both groups did not have a significant difference but its levels increased in the intervention group and decreased in the control group during the study period. Mortality rate insignificantly decreased in the intervention group (p = 0.17). Three patients showed hypotension and tachycardia during the administration of vitamin C which was self-limited with decreasing the dose of vitamin C. Our results showed that the intravenous administration of a relatively high dose of vitamin C to critically ill patients with severe pneumonia was safe and could decrease the inflammation, duration of mechanical ventilation, and vasopressor use without any significant effect on mortality. TRIAL REGISTRATION: IRCT registration number: IRCT20190312043030N1, Registration date: 2019-08-26, Seied Hadi Saghaleini.
Subject(s)
Ascorbic Acid/administration & dosage , Critical Care/methods , Intensive Care Units , Pneumonia/drug therapy , Pneumonia/mortality , Severity of Illness Index , Vitamins/administration & dosage , Administration, Intravenous , Adult , Aged , Ascorbic Acid/blood , Critical Illness , Double-Blind Method , Female , Humans , Length of Stay , Male , Middle Aged , Pneumonia/blood , Respiration, Artificial/adverse effects , Treatment OutcomeSubject(s)
COVID-19/complications , Critical Illness/therapy , Cytokine Release Syndrome/therapy , Hemoperfusion , APACHE , Acute Kidney Injury/etiology , Acute Kidney Injury/therapy , Adult , Antiviral Agents/therapeutic use , COVID-19/blood , COVID-19/therapy , Combined Modality Therapy , Comorbidity , Continuous Renal Replacement Therapy , Cytokine Release Syndrome/etiology , Cytokine Release Syndrome/prevention & control , Female , Humans , Male , Middle Aged , Multiple Organ Failure/etiology , Multiple Organ Failure/therapy , Positive-Pressure Respiration , Prone Position , SARS-CoV-2ABSTRACT
There are many unknown questions and puzzle pieces that should describe the clinical course of COVID-19 and its complications, especially ARDS. We provide the initial immediate surge response to allow every patient in need of an ICU bed to receive one. Till our knowledge is improved, the most important intervention in the treatment of critically ill patients with COVID-19 seems to be the level of standard care and appropriate and early diagnosis and treatment. It seems that each center should have its protocol on the management of critically ill COVID-19 patients regarding prevention, diagnosis, and treatment. This treatment should now be performed regardless of the reason which lies behind the pathophysiology of this disease, which is yet unknown. In this report, we share our experience in the management of critically ill COVID-19 patients during the 2 months in our intensive care unit.