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Vitamin C may reduce the duration of mechanical ventilation in critically ill patients: a meta-regression analysis
Harri Hemilä1, Elizabeth Chalker2
11Department of Public Health, University of Helsinki, POB 41, FI-00014 Helsinki, Finland.
Background:
Our recent meta-analysis indicated that vitamin C may shorten the length of ICU stay and the duration of mechanical ventilation. Here we analyze modification of the vitamin C effect on ventilation time, by the control group ventilation time (which we used as a proxy for severity of disease in the patients of each trial).
Methods:
We searched MEDLINE, Scopus, and the Cochrane Central Register of Controlled Trials and reference lists of relevant publications. We included controlled trials in which the administration of vitamin C was the only difference between the study groups. We did not limit our search to randomized trials and did not require placebo control. We included all doses and all durations of vitamin C administration. One author extracted study characteristics and outcomes from the trial reports and entered the data in a spreadsheet. Both authors checked the data entered against the original reports. We used meta-regression to examine whether the vitamin C effect on ventilation time depends on the duration of ventilation in the control group.
Results:
We identified nine potentially eligible trials, eight of which were included in the meta-analysis. We pooled the results of the eight trials, including 685 patients in total, and found that vitamin C shortened the length of mechanical ventilation on average by 14% (P = 0.00001). However, there was significant heterogeneity in the effect of vitamin C between the trials. Heterogeneity was fully explained by the ventilation time in the untreated control group. Vitamin C was most beneficial for patients with the longest ventilation, corresponding to the most severely ill patients. In five trials including 471 patients requiring ventilation for over 10 h, a dosage of 1-6 g/day of vitamin C shortened ventilation time on average by 25% (P < 0.0001).
Conclusions:
We found strong evidence that vitamin C shortens the duration of mechanical ventilation, but the magnitude of the effect seems to depend on the duration of ventilation in the untreated control group. The level of baseline illness severity should be considered in further research. Different doses should be compared directly in future trials.
Insights
Vitamin C significantly reduces mechanical ventilation duration by 14%, with greater benefits for severely ill patients. Further research should explore optimal dosing and baseline severity in trials.
Area of Science:
- Critical Care Medicine
- Nutritional Science
- Clinical Trials
Background:
- Previous meta-analysis suggested vitamin C may reduce ICU stay and mechanical ventilation duration.
- The current study investigates how patient illness severity, proxied by control group ventilation time, modifies vitamin C's effect on ventilation duration.
Purpose of the Study:
- To analyze the modification of vitamin C's effect on mechanical ventilation duration by the control group's ventilation time.
- To determine if illness severity influences the efficacy of vitamin C in reducing mechanical ventilation time.
Main Methods:
- Systematic literature search of MEDLINE, Scopus, and Cochrane Central Register.
- Inclusion of controlled trials where vitamin C administration was the sole intervention difference.
- Meta-regression analysis to assess the relationship between vitamin C's effect and control group ventilation duration.
Main Results:
- Eight trials with 685 patients showed vitamin C shortened mechanical ventilation by 14% (P=0.00001).
- Significant heterogeneity was observed, fully explained by control group ventilation time.
- Vitamin C demonstrated a 25% reduction in ventilation time for severely ill patients (ventilation >10h) with 1-6g/day dosage (P<0.0001).
Conclusions:
- Vitamin C effectively shortens mechanical ventilation duration, with its magnitude dependent on baseline illness severity.
- Future research should consider baseline illness severity and directly compare different vitamin C doses.
- The findings support vitamin C as a potential therapeutic agent in critical care settings for ventilated patients.
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