Vitamin C in ICU patients- Controversial benefits with lagging evidence

Administration of vitamin C to Intensive care unit patients is a common practice. However, the ability of vitamin C to reduce mortality in critically ill patients remains controversial. In a mixed population of ICU patients, there is no significant effect of vitamin C on survival, length of Intensive care unit (ICU) or hospital stay, according to a study published in the journal, Critical Care Medicine.

While vitamin C was not found to induce a reduction in mortality, acute kidney injury, Intensive care unit (ICU) or hospital length of stay in critically ill patients, administration of vitamin C was found to reduce the postoperative atrial fibrillation, ICU stays, and hospital stays in patients who have undergone cardiac surgery.

Critically ill patients are often diagnosed with a low level of ascorbic acid (AA) for which vitamin C supplementation leads to promising outcomes and hence, it is often given in the form of a cocktail containing high-dose vitamin C, corticosteroids, and thiamine referred to as HAT. However, in many studies, the effects of vitamin C supplementation on survival and quick recovery of patients have been found to be contradicting to this popular practice.

The present study aimed at ascertaining the effects of vitamin C on clinical outcome in critically ill patients where they the authors analyzed forty-four randomized studies in which 16 were performed in ICU setting including 2,857 patients and 28 were performed in cardiac surgery including 3,598 patients, published between 1995 and 2018.

Upon analyzing the trials, it was found that in ICU patients, vitamin C administration was not associated with a difference in mortality, acute kidney injury, ICU or hospital length of stay compared with control.

However, in cardiac surgery, vitamin C was found to be associated with a reduction in postoperative atrial fibrillation, ICU stays, and hospital stays. Furthermore, no differences in postoperative mortality, acute kidney injury, stroke, and ventricular arrhythmia were found.

Based on the findings the authors conclude: In a mixed population of Intensive care unit (ICU) patients, vitamin C administration is associated with no significant effect on survival, length of ICU or hospital stay. In cardiac surgery, beneficial effects on postoperative atrial fibrillation, Intensive care unit or hospital length of stay remain unclear. However, the quality and quantity of evidence are still insufficient to draw firm conclusions, not supporting neither discouraging the systematic administration of vitamin C in these populations. Vitamin C remains an attractive intervention for future investigations aimed to improve clinical outcome.

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doi: 10.1097/CCM.0000000000003700