Vitamin C, Hydrocortisone, and Thiamine for Septic Shock —In Reply

In Reply We agree with Dr Long and colleagues that the timing of interventions is important in the management of sepsis. They suggest that early administration of vitamin C is essential for the intervention to have beneficial effects, even though no data on the timing of intervention were reported in the study by Marik et al. In the VITAMINS trial, an elevated lactate level was required to meet the consensus definition of septic shock. During the study period, sepsis resuscitation in Australasian emergency departments for patients with suspected septic shock was administration of 27 mL/kg of intravenous fluids before starting vasopressors, which were commenced a median of 3.5 hours after triage. Moreover, given that patients in the trial were randomized and that vitamin C concentrations in the intervention group increased from low to supraphysiological levels, it is unlikely that the volume and duration of fluid resuscitation affected the results.
Source: JAMA - Category: General Medicine Source Type: research