Vitamin C for all?

2024-05-20
Current opinion in critical care 30(4)
- Angelique de Man
- Micah T Long
- Christian Stoppe

PubMed: 38841995
DOI: 10.1097/mcc.0000000000001161

Study Design

Type: Review

Purpose of review

Vitamin C can be a potential adjunctive treatment option for critically ill individuals due to its pleiotropic effects as electron donor in many enzymatic reactions throughout the body. Recently, several important randomized controlled trials (RCTs) investigating vitamin C in critically ill patients have been published.

Recent findings

Two recent large RCTs administering high-dose vitamin C to patients with sepsis and COVID-19 showed signs of harm. Though performed at high standard, these trials had several limitations. Recent studies in cardiac surgery and burns showed decreased cardiac enzymes and improved clinical outcomes after cardiac surgery, and decreased fluid requirements, reduced wound healing time and in-hospital mortality after burns. Vitamin C may hold benefit in the management of other ischemia/reperfusion injury populations, including postcardiac arrest patients and after solid organ transplantation. Currently, covering basal vitamin C requirements during critical illness is recommended, though the exact dose remains to be determined.

Summary

Future work should address optimal vitamin C timing, since early versus late drug administration are likely distinct, and duration of therapy, where withdrawal-induced injury is possible. Additionally accurate assessment of body stores with determination of individual vitamin requirements is crucial to ascertain patient and subgroups most likely to benefit from vitamin C.

Research Insights

Vitamin C→Improved Clinical Outcome
Recent studies in cardiac surgery and burns showed decreased cardiac enzymes and improved clinical outcomes after cardiac surgery
Effect
Beneficial
Effect size
Moderate
Dose
high-dose
Vitamin C→Reduced Cardiac Enzyme Level
Recent studies in cardiac surgery and burns showed decreased cardiac enzymes and improved clinical outcomes after cardiac surgery
Effect
Beneficial
Effect size
Moderate
Dose
high-dose
Vitamin C→Reduced Fluid Requirement
decreased fluid requirements, reduced wound healing time and in-hospital mortality after burns
Effect
Beneficial
Effect size
Moderate
Dose
high-dose
Vitamin C→Reduced In-hospital Mortality
decreased fluid requirements, reduced wound healing time and in-hospital mortality after burns
Effect
Beneficial
Effect size
Moderate
Dose
high-dose
Vitamin C→Reduced Mortality Risk
Two recent large RCTs administering high-dose vitamin C to patients with sepsis and COVID-19 showed signs of harm.
Effect
Harmful
Effect size
Moderate
Dose
high-dose
Vitamin C→Reduced Wound Healing Time
decreased fluid requirements, reduced wound healing time and in-hospital mortality after burns
Effect
Beneficial
Effect size
Moderate
Dose
high-dose

Adverse Events Reported

Vitamin C→Overall tolerability
Two recent large RCTs administering high-dose vitamin C to patients with sepsis and COVID-19 showed signs of harm.
Finding
Reported