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Crit Care. 2018 Oct 29;22(1):283. doi: 10.1186/s13054-018-2217-4.

Ascorbic acid, corticosteroids, and thiamine in sepsis: a review of the biologic rationale and the present state of clinical evaluation.

Author information

1
Beth Israel Deaconess Medical Center, Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Boston, MA, USA.
2
Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, MA, USA.
3
Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark.
4
Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark.
5
Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
6
Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
7
Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA.
8
Department of Emergency Medicine, Wayne State University School of Medicine/Detroit Receiving Hospital, Detroit, MI, USA.
9
Division of Emergency Critical Care Medicine, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.
10
Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
11
Feinstein Institute for Medical Research, Manhasset, NY, USA.
12
Department of Anesthesia Critical Care, Division of Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA.
13
Department of Emergency Medicine and Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA.
14
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, New Hyde Park, NY, USA.
15
Department of Critical Care Medicine, Mayo Clinic, Phoenix, AZ, USA.
16
Beth Israel Deaconess Medical Center, Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Boston, MA, USA. mdonnino@bidmc.harvard.edu.
17
Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, MA, USA. mdonnino@bidmc.harvard.edu.
18
Beth Israel Deaconess Medical Center, Emergency Medicine, One Deaconess Rd, W/CC 2, Boston, MA, 02215, USA. mdonnino@bidmc.harvard.edu.

Abstract

The combination of thiamine, ascorbic acid, and hydrocortisone has recently emerged as a potential adjunctive therapy to antibiotics, infectious source control, and supportive care for patients with sepsis and septic shock. In the present manuscript, we provide a comprehensive review of the pathophysiologic basis and supporting research for each element of the thiamine, ascorbic acid, and hydrocortisone drug combination in sepsis. In addition, we describe potential areas of synergy between these therapies and discuss the strengths/weaknesses of the two studies to date which have evaluated the drug combination in patients with severe infection. Finally, we describe the current state of current clinical practice as it relates to the thiamine, ascorbic acid, and hydrocortisone combination and present an overview of the randomized, placebo-controlled, multi-center Ascorbic acid, Corticosteroids, and Thiamine in Sepsis (ACTS) trial and other planned/ongoing randomized clinical trials.

KEYWORDS:

Ascorbic acid; Corticosteroids; Metabolic resuscitation; Sepsis; Thiamine

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