ascorbic-acid and Respiratory-Insufficiency

Sepsis is a common syndrome with substantial morbidity and mortality. A combination of vitamin C, thiamine, and corticosteroids has been proposed as a potential treatment for patients with sepsis.. To determine whether a combination of vitamin C, thiamine, and hydrocortisone every 6 hours increases ventilator- and vasopressor-free days compared with placebo in patients with sepsis.. Multicenter, randomized, double-blind, adaptive-sample-size, placebo-controlled trial conducted in adult patients with sepsis-induced respiratory and/or cardiovascular dysfunction. Participants were enrolled in the emergency departments or intensive care units at 43 hospitals in the United States between August 2018 and July 2019. After enrollment of 501 participants, funding was withheld, leading to an administrative termination of the trial. All study-related follow-up was completed by January 2020.. Participants were randomized to receive intravenous vitamin C (1.5 g), thiamine (100 mg), and hydrocortisone (50 mg) every 6 hours (n = 252) or matching placebo (n = 249) for 96 hours or until discharge from the intensive care unit or death. Participants could be treated with open-label corticosteroids by the clinical team, with study hydrocortisone or matching placebo withheld if the total daily dose was greater or equal to the equivalent of 200 mg of hydrocortisone.. The primary outcome was the number of consecutive ventilator- and vasopressor-free days in the first 30 days following the day of randomization. The key secondary outcome was 30-day mortality.. Among 501 participants randomized (median age, 62 [interquartile range {IQR}, 50-70] years; 46% female; 30% Black; median Acute Physiology and Chronic Health Evaluation II score, 27 [IQR, 20.8-33.0]; median Sequential Organ Failure Assessment score, 9 [IQR, 7-12]), all completed the trial. Open-label corticosteroids were prescribed to 33% and 32% of the intervention and control groups, respectively. Ventilator- and vasopressor-free days were a median of 25 days (IQR, 0-29 days) in the intervention group and 26 days (IQR, 0-28 days) in the placebo group, with a median difference of -1 day (95% CI, -4 to 2 days; P = .85). Thirty-day mortality was 22% in the intervention group and 24% in the placebo group.. Among critically ill patients with sepsis, treatment with vitamin C, thiamine, and hydrocortisone, compared with placebo, did not significantly increase ventilator- and vasopressor-free days within 30 days. However, the trial was terminated early for administrative reasons and may have been underpowered to detect a clinically important difference.. ClinicalTrials.gov Identifier: NCT03509350.

Topics: Adult; Aged; Anti-Inflammatory Agents; Ascorbic Acid; Critical Illness; Double-Blind Method; Drug Therapy, Combination; Early Termination of Clinical Trials; Female; Humans; Hydrocortisone; Length of Stay; Male; Middle Aged; Organ Dysfunction Scores; Respiration, Artificial; Respiratory Insufficiency; Sepsis; Thiamine; Treatment Outcome; Vasoconstrictor Agents; Vitamins

Topics: Ascorbic Acid; Biomarkers; Humans; Inflammation; Respiratory Insufficiency; Sepsis; Vascular System Injuries

Topics: Ascorbic Acid; Biomarkers; Humans; Inflammation; Respiratory Insufficiency; Sepsis; Vascular System Injuries

Topics: Ascorbic Acid; Humans; Respiratory Distress Syndrome; Respiratory Insufficiency; Sepsis; Vitamins

Methemoglobinemia is a rare disorder of the blood in which there is an increase in methemoglobin, which occurs when hemoglobin is present in the oxidized form. Methemoglobin impairs hemoglobin's ability to transport oxygen, produces functional anemia, and leads to tissue hypoxia. We report the successful management of a case of refractory hypoxia due to acutely acquired methemoglobinemia in a patient undergoing treatment for coronavirus disease 2019 (COVID-19) pneumonia. The cause of methemoglobinemia in this patient remains unknown. Hypoxia and methemoglobinemia did not respond to methylene blue and required administration of packed red blood cell transfusions.

Topics: Acute Kidney Injury; Aged; Antibodies, Monoclonal, Humanized; Antioxidants; Ascorbic Acid; Betacoronavirus; Coronavirus Infections; Corynebacterium; Corynebacterium Infections; COVID-19; Cytokine Release Syndrome; Enzyme Inhibitors; Erythrocyte Transfusion; Hematinics; Humans; Hydroxocobalamin; Hydroxychloroquine; Hypoxia; Male; Methemoglobinemia; Methylene Blue; Pandemics; Pneumonia, Bacterial; Pneumonia, Viral; Renal Replacement Therapy; Respiratory Insufficiency; SARS-CoV-2; Shock, Septic

Topics: Ascorbic Acid; Biomarkers; Humans; Respiratory Insufficiency; Sepsis; Vascular System Injuries

Topics: Ascorbic Acid; Biomarkers; Humans; Inflammation; Respiratory Distress Syndrome; Respiratory Insufficiency; Sepsis; Vascular System Injuries

Topics: Ascorbic Acid; Biomarkers; Humans; Inflammation; Respiratory Distress Syndrome; Respiratory Insufficiency; Sepsis; Vascular System Injuries

Topics: Acetylcysteine; Acute Kidney Injury; Adult; Ascorbic Acid; Charcoal; Chemical and Drug Induced Liver Injury; Combined Modality Therapy; Diuretics; Fatal Outcome; Furosemide; Gastric Lavage; Hemoperfusion; Humans; Immunosuppressive Agents; Male; Paraquat; Poisoning; Pulmonary Fibrosis; Respiration, Artificial; Respiratory Insufficiency; Rhabdomyolysis; Suicide, Attempted; Vitamin E

Topics: Ascorbic Acid; Azathioprine; Blood Gas Analysis; Dapsone; Female; Follow-Up Studies; Humans; Hypercapnia; Hypoxia; Methemoglobinemia; Methylene Blue; Middle Aged; Myositis; Oximetry; Polysomnography; Prednisone; Respiratory Function Tests; Respiratory Insufficiency; Risk Assessment; Severity of Illness Index; Treatment Outcome

Topics: Adult; Ascorbic Acid; Byssinosis; Dust; Female; Histamine H1 Antagonists; Humans; Metaproterenol; Occupational Medicine; Respiratory Function Tests; Respiratory Insufficiency; Spirometry; Textile Industry

Topics: Adenocarcinoma, Bronchiolo-Alveolar; Aging; Angioedema; Ascorbic Acid; Common Cold; Food; Headache; History, 20th Century; Hormones; Humans; Respiratory Insufficiency; Therapeutics

Topics: Administration, Oral; Adult; Aged; Ascorbic Acid; Aspirin; Asthma; Drug Combinations; Female; Histamine H1 Antagonists; Humans; Male; Middle Aged; Piperazines; Respiratory Insufficiency; Rhinitis, Allergic, Seasonal; Triamcinolone

Topics: Adult; Ascorbic Acid; Barbiturates; Caffeine; Female; Humans; Hypoxia; Male; Middle Aged; Oxygen Consumption; Respiratory Insufficiency; Strychnine; Thiamine; Vascular Resistance