Background: Critically ill patients frequently suffer from vitamin C deficiency. Previous studies showed that high doses of vitamin C administration had conflicting results on clinical outcomes in patients with severe sepsis, burns and trauma. Because of the high incidence and morbidity/mortality with severe pneumonia, we aimed to investigate the effect of administration of high dose vitamin C in critically ill patients with severe pneumonia.
Methods: Eighty critically ill patients with pneumonia were enrolled in this randomized double blinded clinical trial. Patients with CURB-65 score >3, one major criteria, or ≥3 minor criteria were considered as severe pneumonia. Patients were randomly assigned to intervention or placebo groups receiving standard treatment plus 60 mg/kg/day vitamin C as continuous infusion or normal saline in the same volume correspondingly for 96 hours. Serum levels of vitamin C were noted at baseline and 48 hours after vitamin C administration. Duration of mechanical ventilation, ICU length of stay, PaO 2 /FiO 2 and mortality rate were noted for all patients till the 28 th day. Any complications related to the vitamin C administration were recorded. (IRCT registration number: IRCT20190312043030N1 , Registration date: 2019-08-26 , seied hadi saghaleini).
Results: Duration of mechanical ventilation and vasopressor use were significantly lower in intervention group ( p : <0.001 and 0.003, respectively). Baseline levels of vitamin C in both groups did not have significant difference but its levels increased in intervention group and decreased in control group during the study period. Mortality rate insignificantly decreased in intervention group ( p : 0.17). Three patients showed hypotension and tachycardia during the administration of vitamin C which was self-limited with decreasing the dose of vitamin C.
Conclusion: Our results showed that the intravenous administration of a relatively high dose of vitamin C to critically ill patients with severe pneumonia was safe and could decrease the inflammation, duration of mechanical ventilation and vasopressor use without any significant effect on mortality ( P value: 0.17).