Evaluation of the outcome and adverse event of intravenous Vitamin C in the treatment of septic shock or acute respiratory distress syndrome (ARDS) among patients admitted to the intensive care unit (ICU) of a tertiary hospital in Malaysia

Introduction: 
Numerous studies have suggested that Vitamin C may enhance sepsis recovery and improve clinical outcome in acute respiratory distress syndrome (ARDS) through its effect in attenuating organ failure and improving the microcirculation and hemodynamic parameters.     

Methodology: 
A retrospective observational study was conducted between 2018 and 2020 among patients admitted to the intensive care unit and received intravenous vitamin C for septic shock or ARDS (N=35). Primary outcome was the vasopressor and ventilator-free-days at day 28 of treatment.     

Results: 
The vasopressor and ventilator-free-day at day 28 of intravenous vitamin C was 9 days (IQR 0,25) and 12 days (IQR 0,22) respectively; which was shorter compared to the VICTAS study (25 days). Resolution of shock was observed in 66% of the patients (n=23) within 46 hours and this finding was consistent with the results of HYVCTTSSS study. The vasopressor requirement was reduced for 36% within 24 hours of treatment (from 0.63mcg/kg/min to 0.4mcg/kg/min of Norepinehrine equivalent doses). However, the 28-day all-cause mortality rate was higher compared to other studies (55% vs 20-35%). This may be due to the high SOFA score (14 and above) among these patients prior to treatment and a delay in treatment from the onset of shock (> 24 hours as recommended in 10 out of the 19 deceased patients).     

Conclusions: 
Although the 28-day all-cause mortality rate was higher in our patients, rapid resolution of shock was observed among those who responded to the intravenous vitamin C treatment.