Related Experiment Video
Updated: Jul 5, 2025
A Rat Model of Ventricular Fibrillation and Resuscitation by Conventional Closed-chest Technique
Published on: April 26, 2015
Resuscitation With Vitamin C, Hydrocortisone, and Thiamin in Children With Septic Shock: A Multicenter Randomized
Luregn J Schlapbach1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16, Sainath Raman1,2, David Buckley4
1Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia.
Insights
This pilot study found that administering vitamin C, hydrocortisone, and thiamin to pediatric intensive care unit patients with septic shock was feasible. Further research is needed to determine the intervention
Area of Science:
- Pediatric critical care medicine
- Septic shock management
- Adjunctive therapies
Background:
- Limited randomized controlled trial (RCT) data exists for adjunctive vitamin C, hydrocortisone, and thiamin in pediatric septic shock.
- Previous studies in adults suggest potential benefits, necessitating pediatric investigation.
- Septic shock in children requires effective and safe treatment strategies.
Purpose of the Study:
- To assess the feasibility of administering vitamin C, hydrocortisone, and thiamin to pediatric intensive care unit (PICU) patients with septic shock.
- To explore the association between this adjunctive therapy and improved survival free of organ dysfunction.
- To inform the design of a larger, definitive randomized controlled trial.
Main Methods:
- An open-label, parallel, pilot randomized controlled trial (RCT) was conducted across six PICUs in Australia and New Zealand.
- Eligible patients (28 days to 18 years) with septic shock requiring vasoactive drugs were randomized (1:1) to receive either the intervention or standard care.
- The primary endpoint was feasibility, with secondary clinical endpoints including survival free of organ dysfunction, shock reversal, and intervention efficacy proxies.
Main Results:
- Feasibility was demonstrated, with 78% of eligible patients consenting and 91% of approached parents providing consent.
- Median survival free of organ dysfunction was comparable between the intervention (20.0 days) and standard care (21.0 days) groups.
- No significant difference was observed in shock reversal times between the groups, though the intervention group showed a trend towards faster resolution.
Conclusions:
- The adjunctive therapy protocol involving high-dose vitamin C, hydrocortisone, and thiamin is feasible in children with septic shock requiring vasopressors.
- The study provides valuable data for refining the protocol for a larger, more robust RCT.
- Further investigation is warranted to definitively establish the efficacy and optimal use of this combination therapy in pediatric septic shock.
Objectives:
Adjunctive therapy with vitamin C, hydrocortisone, and thiamin has been evaluated in adults, but randomized controlled trial (RCT) data in children are lacking. We aimed to test the feasibility of vitamin C, hydrocortisone, and thiamin in PICU patients with septic shock; and to explore whether the intervention is associated with increased survival free of organ dysfunction.
Design:
Open-label parallel, pilot RCT multicenter study. The primary endpoint was feasibility. Clinical endpoints included survival free of organ dysfunction censored at 28 days and nine secondary outcomes, shock reversal, and two proxy measures of intervention efficacy.
Setting:
Six PICUs in Australia and New Zealand.
Patients:
Children of age between 28 days and 18 years requiring vasoactive drugs for septic shock between August 2019 and March 2021.
Interventions:
Patients were assigned 1:1 to receive 1 mg/kg hydrocortisone every 6 hours (q6h), 30 mg/kg ascorbic acid q6h, and 4 mg/kg thiamin every 12 hours (n = 27), or standard septic shock management (n = 33).
Measurements And Main Results:
Sixty of 77 (78%) eligible patients consented with 91% of approached parents providing consent. The median time from randomization to intervention was 44 (interquartile range [IQR] 29-120) min. Seventy of seventy-seven (28%) patients had received IV steroids before randomization. Median survival alive and free of organ dysfunction was 20.0 (0.0-26.0) days in the intervention and 21.0 (0.0-25.0) days in the standard care group. Median PICU length of stay was 5.3 (2.5-11.3) days in the intervention group versus 6.9 (3.0-11.5) days in the control group. Shock reversal occurred at a median of 35.2 (14.6-101.2) hours in the intervention group versus 47.3 (22.4-106.8) hours in the standard care group (median difference -12 hr; 95% CI, -56.8 to 32.7 hr).
Conclusions:
In children requiring vasopressors for septic shock, a protocol comparing adjunctive treatment with high-dose vitamin C, hydrocortisone, and thiamin versus standard care was feasible. These findings assist in making modifications to the trial protocol to enable a better-designed larger RCT.
Related Concept Videos
01:29Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...
01:24Blood Pressure Imbalances and Circulatory Shock
Blood Pressure: Hypertension and Hypotension
Normal blood pressure is 120/80 mm Hg. Elevated blood pressure is 120-129/under 80 mm Hg. Hypertension, warranting treatment at 130/80 mm Hg, is often asymptomatic and can lead to severe cardiovascular events, aneurysms, peripheral arterial disease, chronic renal disease, or cardiac...
01:22Methods of reducing fever
Pharmacological Methods of Reducing Fever: