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Hydrocortisone, Vitamin C and thiamine for the treatment of sepsis and septic shock following cardiac surgery

BACKGROUND AND AIMS: The effect of vitamin C on vasopressor requirement in critically ill patients have been evaluated previously. We aimed to evaluate the effect of vitamin C, hydrocortisone and thiamine on vasopressor requirement and mortality in post-operative adult cardiac surgical patients with...

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Autores principales: Balakrishnan, Mahesh, Gandhi, Hemang, Shah, Komal, Pandya, Himani, Patel, Ramesh, Keshwani, Sunny, Yadav, Nikhil
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6299773/
https://www.ncbi.nlm.nih.gov/pubmed/30636793
http://dx.doi.org/10.4103/ija.IJA_361_18
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author Balakrishnan, Mahesh
Gandhi, Hemang
Shah, Komal
Pandya, Himani
Patel, Ramesh
Keshwani, Sunny
Yadav, Nikhil
author_facet Balakrishnan, Mahesh
Gandhi, Hemang
Shah, Komal
Pandya, Himani
Patel, Ramesh
Keshwani, Sunny
Yadav, Nikhil
author_sort Balakrishnan, Mahesh
collection PubMed
description BACKGROUND AND AIMS: The effect of vitamin C on vasopressor requirement in critically ill patients have been evaluated previously. We aimed to evaluate the effect of vitamin C, hydrocortisone and thiamine on vasopressor requirement and mortality in post-operative adult cardiac surgical patients with septic shock. METHODS: About 24 patients with septic shock were randomised into Group 1 (receiving matching placebo per day for 4 days) and Group 2 (receiving 6 g vitamin C, 400 mg thiamine and 200 mg hydrocortisone per day for 4 days). Vasopressor dose over 4 days of therapy was the primary endpoint, whereas in-hospital mortality was the secondary endpoint. RESULTS: APACHE IV and EUROSCORE II scores were similar between both the groups. Significant reductions in the requirement of vasopressin (difference from day 1 – 0.0008 ± 0.00289 vs 0.0033 ± 0.00492 units/kg/min; P = 0.019) and noradrenaline (difference from day 1 – 0.0283 ± 0.040 vs 0.023 ± 0.035 μg/kg/min; P = 0.006) were observed with vitamin C treatment as compared to control group. PCT levels on Day 3 (68.11 ± 33.64 vs 33.2 ± 27.55 ng/mL; P = 0.0161) and Day 4 (70.03 ± 29.74 vs 26.3 ± 23.08 ng/mL; P = 0.0009) were significantly lower in treatment group as compared to control. However, there was no difference in the Sepsis-Related Organ Failure Assessment (SOFA) score and mortality between the studied groups. CONCLUSION: Combination of vitamin C, thiamine and hydrocortisone reduces vasopressor requirement in adult cardiac surgical patients with septic shock.
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spelling pubmed-62997732019-01-11 Hydrocortisone, Vitamin C and thiamine for the treatment of sepsis and septic shock following cardiac surgery Balakrishnan, Mahesh Gandhi, Hemang Shah, Komal Pandya, Himani Patel, Ramesh Keshwani, Sunny Yadav, Nikhil Indian J Anaesth Original Article BACKGROUND AND AIMS: The effect of vitamin C on vasopressor requirement in critically ill patients have been evaluated previously. We aimed to evaluate the effect of vitamin C, hydrocortisone and thiamine on vasopressor requirement and mortality in post-operative adult cardiac surgical patients with septic shock. METHODS: About 24 patients with septic shock were randomised into Group 1 (receiving matching placebo per day for 4 days) and Group 2 (receiving 6 g vitamin C, 400 mg thiamine and 200 mg hydrocortisone per day for 4 days). Vasopressor dose over 4 days of therapy was the primary endpoint, whereas in-hospital mortality was the secondary endpoint. RESULTS: APACHE IV and EUROSCORE II scores were similar between both the groups. Significant reductions in the requirement of vasopressin (difference from day 1 – 0.0008 ± 0.00289 vs 0.0033 ± 0.00492 units/kg/min; P = 0.019) and noradrenaline (difference from day 1 – 0.0283 ± 0.040 vs 0.023 ± 0.035 μg/kg/min; P = 0.006) were observed with vitamin C treatment as compared to control group. PCT levels on Day 3 (68.11 ± 33.64 vs 33.2 ± 27.55 ng/mL; P = 0.0161) and Day 4 (70.03 ± 29.74 vs 26.3 ± 23.08 ng/mL; P = 0.0009) were significantly lower in treatment group as compared to control. However, there was no difference in the Sepsis-Related Organ Failure Assessment (SOFA) score and mortality between the studied groups. CONCLUSION: Combination of vitamin C, thiamine and hydrocortisone reduces vasopressor requirement in adult cardiac surgical patients with septic shock. Medknow Publications & Media Pvt Ltd 2018-12 /pmc/articles/PMC6299773/ /pubmed/30636793 http://dx.doi.org/10.4103/ija.IJA_361_18 Text en Copyright: © 2018 Indian Journal of Anaesthesia http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Balakrishnan, Mahesh
Gandhi, Hemang
Shah, Komal
Pandya, Himani
Patel, Ramesh
Keshwani, Sunny
Yadav, Nikhil
Hydrocortisone, Vitamin C and thiamine for the treatment of sepsis and septic shock following cardiac surgery
title Hydrocortisone, Vitamin C and thiamine for the treatment of sepsis and septic shock following cardiac surgery
title_full Hydrocortisone, Vitamin C and thiamine for the treatment of sepsis and septic shock following cardiac surgery
title_fullStr Hydrocortisone, Vitamin C and thiamine for the treatment of sepsis and septic shock following cardiac surgery
title_full_unstemmed Hydrocortisone, Vitamin C and thiamine for the treatment of sepsis and septic shock following cardiac surgery
title_short Hydrocortisone, Vitamin C and thiamine for the treatment of sepsis and septic shock following cardiac surgery
title_sort hydrocortisone, vitamin c and thiamine for the treatment of sepsis and septic shock following cardiac surgery
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6299773/
https://www.ncbi.nlm.nih.gov/pubmed/30636793
http://dx.doi.org/10.4103/ija.IJA_361_18
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