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Resuscitation in Paediatric Septic Shock Using Vitamin C and Hydrocortisone (RESPOND): The RESPOND Randomized
Sainath Raman1,2, Kristen S Gibbons1, Muralidharan Jayashree3
1Children's Intensive Care Research Program, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
Insights
This study investigates if vitamin C and hydrocortisone improve survival in pediatric septic shock. The goal is to reduce the need for vasopressors in critically ill children.
Area of Science:
- Pediatric critical care medicine
- Pharmacology
- Clinical trial research
Background:
- Pediatric sepsis is a life-threatening condition with high morbidity and mortality globally.
- Early adjunctive therapies are crucial for improving outcomes in pediatric septic shock.
- Current standard care for pediatric septic shock requires optimization.
Purpose of the Study:
- To evaluate the efficacy of combined vitamin C and hydrocortisone versus hydrocortisone alone or standard care in pediatric septic shock.
- To determine if this combination therapy increases survival free of inotropes/vasopressors support until day 7.
- To assess secondary outcomes including mortality, organ support, and long-term functional status.
Main Methods:
- A randomized, open-label, controlled, three-arm trial (RESPOND) involving nine Australian and New Zealand Pediatric Intensive Care Units (PICUs).
- Participants are children aged 7 days to 18 years with suspected or confirmed sepsis receiving inotropes/vasopressors for over 1 hour.
- Interventions include IV vitamin C plus hydrocortisone, IV hydrocortisone alone, or standard care, with 384 children to be enrolled in a 1:1:1 ratio.
Main Results:
- The primary outcome is time alive and free of inotropes/vasopressors support, censored at 7 days.
- Secondary outcomes encompass 28-day mortality, duration of organ support, PICU length of stay, quality of life, and neurodevelopmental outcomes at 6 months.
- The study employs an intention-to-treat principle for statistical analysis.
Conclusions:
- The findings will inform clinical practice regarding the use of vitamin C and hydrocortisone in pediatric septic shock.
- Results will be disseminated through peer-reviewed publications and international conference presentations.
- The study aims to contribute valuable data for optimizing the management of critically ill children with sepsis.
Objectives:
Pediatric sepsis results in significant morbidity and mortality worldwide. There is an urgent need to investigate adjunctive therapies that can be administered early. We hypothesize that using vitamin C combined with hydrocortisone increases survival free of inotropes/vasopressors support until day 7 compared with standard care. Here we describe the Resuscitation in Paediatric Septic Shock using Vitamin C and Hydrocortisone (RESPOND) trial protocol, which aims to address this hypothesis.
Design:
Randomized, open label, controlled, parallel-group, three-arm trial with integrated economic evaluation.
Setting:
Nine Australia and New Zealand PICUs, with interest from additional international sites.
Patients:
Children between 7 days and younger than 18 years old who are treated for suspected or confirmed sepsis and receiving inotropes/vasopressors for greater than 1 hour.
Interventions:
IV vitamin C (100 mg/kg [maximum 5 g] every 6 hr) and hydrocortisone (1 mg/kg [maximum 50 mg] every 6 hr), or IV hydrocortisone alone (1 mg/kg [maximum 50 mg] every 6 hr) or standard care.
Measurements And Main Results:
Three hundred eighty-four children will be randomly assigned to receive the interventions, or standard care in a 1:1:1 ratio with stratification by steroid administration pre-randomization and hospital site. The primary outcome is time alive and free of inotropes/vasopressors, censored at 7 days. Secondary outcomes include 28-day mortality, survival free of organ support, PICU length of stay, quality of life, functional status and neurodevelopmental vulnerability at 6 months post-enrollment, and hospitalization-related costs. Statistical analysis will be based on an intention-to-treat principle. The study has ethical approval (HREC/20/QCHQ/69922, dated December 21, 2020), is registered in the Australian New Zealand Clinical Trials Registry (ACTRN12621000247875), commenced recruitment on December 8, 2021, and is expected to finish recruitment by mid-2026.
Conclusions:
Dissemination of the results will occur through publication in peer-reviewed journals, presentations at international conferences, and additional consumer-informed pathways.
