Evaluation of Parenteral Vitamin C's Effectiveness in Critically Ill Patients: A Systematic Review and Critical Appraisal

TL;DR

This review examines whether giving vitamin C directly into the bloodstream helps critically ill patients with severe infections, finding mixed results on its effectiveness.

Contribution

The paper provides a systematic review and critical appraisal of parenteral vitamin C's clinical effectiveness in severe infections, highlighting gaps in current evidence.

Findings

Parenteral vitamin C may improve immune function and reduce oxidative stress in critically ill patients.

Larger systematic reviews and meta-analyses did not show significant mortality reduction with vitamin C.

Clinical benefits like improved survival or recovery remain uncertain and require further study.

Abstract

Vitamin C, a key nutrient with potent antioxidant and immunomodulatory properties, has been explored for its therapeutic potential in treating severe infections, particularly sepsis. This systematic review aims to evaluate the effectiveness of parenteral vitamin C in improving clinical outcomes in patients with severe infections. A comprehensive search of several databases, including PubMed, EMBASE, and the Cochrane Library, was conducted for studies published between January 2000 and June 2024. Included were randomized controlled trials, observational studies, and case reports that examined the use of parenteral vitamin C in adult patients with severe infections. Data extracted included study design, sample size, intervention specifics, and clinical outcomes. Quality was assessed using tools appropriate to each study design, such as the Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale. The review included nine studies with diverse methodologies. While individual studies reported benefits such as improved immune function and reduced oxidative stress, larger systematic reviews and meta-analyses did not demonstrate a significant reduction in mortality. The results indicate that while parenteral vitamin C may improve certain biochemical and physiological parameters, these improvements do not consistently translate into enhanced survival or substantial clinical benefits. Parenteral vitamin C shows potential in modulating immune response and reducing oxidative damage in severe infections. However, its impact on key clinical outcomes like mortality and long-term recovery remains uncertain. This review highlights the need for further high-quality, randomized controlled trials to clarify vitamin C's role in managing severe infections and define optimal therapeutic protocols.

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