Vitamin C - ICU Wonder Drug?

Written by Clay Smith

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Use of vitamin C in a mixed ICU population did not appear to reduce mortality or improve other important outcomes, though there may be other benefits in a cohort of post-op cardiac surgery patients.

Why does this matter?
Recent ICU cocktails with vitamin C, thiamine, and hydrocortisone were reported to drastically improve outcome in a case series of ICU patients, though many viewed these results as preliminary but not yet practice changing. Current trials underway will hopefully shed more light.

Linus Pauling - My Love Affair with Vitamin C
In this meta-analysis of 16 mixed ICU studies and 28 cardiac surgery studies, there was no difference in mortality, acute kidney injury (AKI), ICU/hospital length of stay (LOS) compared to control patients in the ICU-based studies. In cardiac surgery patients, there was a lower risk of post-op atrial fibrillation and decreased ICU and hospital LOS but no impact on mortality, AKI, or ventricular arrhythmia. Several of the studies combined vitamin C with a slurry of other vitamins, NAC, etc. In subgroup analysis with just vitamin C, there was also no improvement in mortality. At this point, it doesn’t appear that vitamin C is the magic bullet for critically ill patients. Before you change your practice and implement a vitamin cocktail, remember what The Skeptics Guide to EM said, "The plural form of anecdote is not data." It may be best to wait for upcoming trials already completed or underway (when I checked clinicaltrials.gov this week) to investigate this more thoroughly.

Source
The Effect of Vitamin C on Clinical Outcome in Critically Ill Patients: A Systematic Review With Meta-Analysis of Randomized Controlled Trials. Crit Care Med. 2019 Feb 26. doi: 10.1097/CCM.0000000000003700. [Epub ahead of print]

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Reviewed by Thomas Davis

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