Tuesday, October 1, 2019

Vit C in Sepsis-induced ARDS

PulmCrit (EMCrit)
PulmCrit - October 1, 2019 - By Josh Farkas
"Summary The Bullet: 
  • CITRIS-ALI is a multi-center RCT investigating IV vitamin C in patients with sepsis-induced ARDS. Vitamin C was initiated relatively late in the disease course (up to 48 hours after the development of end-organ failure meeting ARDS criteria).
  • The primary endpoints of this trial were negative (including change in SOFA score over 96 hours and two biomarkers). However, some secondary endpoints suggested benefit from Vitamin C (including improvements in mortality and ICU-free days).
  • It’s possible that mortality differences could have biased the primary endpoint (SOFA score), due to selective elimination of sicker patients from the control group. Thus, it's conceivable that the secondary endpoint staged a coup d’état, overthrowing the primary endpoint.
  • No evidence of harm from IV vitamin C was found (despite use of larger doses than used in Paul Marik’s study)."