패혈증 비타민/스테로이드 요법, Vitamin C(ascorbic acid), Hydrocortisone, Thiamine

 

Septic shock, Vitamin C, Thiamine, Hydrocortisone

성분명	효과
Vitamin C (ascorbic acid)	🌱anti-inflammatory & antiosidant property 🌱A: 0 mg/kg/day, B: 50 mg/kg/day, C: 200 mg/kg/day, #4 over 30min for 96hr 🌱attenuation of the proinflammatory mediators, enhanced alveolar epithelial barrier function, increased alveolar fluid clearance, and prevention of sepsis-induced coagulopathy
hydrocortisone	🌱Hydrocortisone for relative adrenal insufficiency among patients with sepsis has been studied in randomized controlled trials and in systematic reviews. 🌱Crit Care Med. 2018;46:1411–1420. - 대부분의 연구에서 hydrocortisone 사용, 그 외 methyprednisolone, prednisolone, dexamethasone 사용, addition to fludrocortisone 연구도 존재(n=2), dose of corticosteroid 다양하지만 대부분의 경우 low dose(< 400 mg/day ;as hydrocortisone) & shor course of therapy(< 3 day) - In critically ill patients with sepsis, corticosteroids possibly result in a small reduction in mortality while also possibly increasing the risk of neuromuscular weakness. 🌱N Engl J Med. 2018;378:809–18. - Hydrocortisone was administered as a 50-mg intravenous bolus every 6 hours, and fludrocortisone was given as a 50-μg tablet through a nasogastric tube once daily in the morning. Trial agents were administered for 7 days without tapering.   - In conclusion, 7-day treatment with a 50-mg intravenous bolus of hydrocortisone every 6 hours and a daily dose of 50 μg of oral fludrocortisone resulted in lower mortality at day 90 and at ICU and hospital discharge than placebo among adults with septic shock.
Thiamine	🌱critically ill patients with sepsis의 20%가 thiamine deficiency 🌱thiamine supplementation → lactate clearance 개선 🌱High-dose thiamine (500 mg) was the most frequently ordered dose 🌱Nearly two thirds of the thiamine group received high-dose thiamine, which is consistent with a common practice at the study institution of prescribing 500 mg IV every 8 hours for 72 hours. 🌱Higher thiamine doses may offer the advantage of improved passive absorption into the CNS and improvements in thiamine exposure due to the rapid elimination of thiamine from the serum into the urine.

 

Regimen

성분명	Vitamin C	hydrocortisone	thiamine
용량/용법	1.5 g q6h	50 mg q6h	200 mg q12h
투여	over 30-60 min	over 30-60 min(bolus 가능)	over 30-60 min(bolus 가능)
기한	3-4일 혹은 ICU 퇴실까지

 

 

 

reference : 

1) Woolum, Jordan A., et al. "Effect of thiamine administration on lactate clearance and mortality in patients with septic shock." Critical care medicine 46.11 (2018): 1747-1752.

2) Fujii, Tomoko, et al. "Effect of vitamin C, hydrocortisone, and thiamine vs hydrocortisone alone on time alive and free of vasopressor support among patients with septic shock: the vitamins randomized clinical trial." Jama 323.5 (2020): 423-431.

3) Syed, Aamer A., et al. "Phase I safety trial of intravenous ascorbic acid in patients with severe sepsis." Journal of translational medicine 12.1 (2014): 32.

4) Annane, Djillali, et al. "Hydrocortisone plus fludrocortisone for adults with septic shock." New England Journal of Medicine 378.9 (2018): 809-818.

5) Rochwerg, Bram, et al. "Corticosteroids in sepsis: an updated systematic review and meta-analysis." Critical care medicine 46.9 (2018): 1411-1420.