Ascorbic acid, corticosteroids, and thiamine in sepsis: a review of the biologic rationale and the present state of clinical evaluation

Ari Moskowitz, Lars W. Andersen, David T. Huang, Katherine M. Berg, Anne V. Grossestreuer, Paul E. Marik, Robert L. Sherwin, Peter C. Hou, Lance B. Becker, Michael N. Cocchi, Pratik Doshi, Jonathan Gong, Ayan Sen, Michael W. Donnino

Research output: Contribution to journalReview articlepeer-review

44 Scopus citations

Abstract

The combination of thiamine, ascorbic acid, and hydrocortisone has recently emerged as a potential adjunctive therapy to antibiotics, infectious source control, and supportive care for patients with sepsis and septic shock. In the present manuscript, we provide a comprehensive review of the pathophysiologic basis and supporting research for each element of the thiamine, ascorbic acid, and hydrocortisone drug combination in sepsis. In addition, we describe potential areas of synergy between these therapies and discuss the strengths/weaknesses of the two studies to date which have evaluated the drug combination in patients with severe infection. Finally, we describe the current state of current clinical practice as it relates to the thiamine, ascorbic acid, and hydrocortisone combination and present an overview of the randomized, placebo-controlled, multi-center Ascorbic acid, Corticosteroids, and Thiamine in Sepsis (ACTS) trial and other planned/ongoing randomized clinical trials.

Original languageEnglish (US)
Article number283
JournalCritical Care
Volume22
Issue number1
DOIs
StatePublished - Oct 29 2018
Externally publishedYes

Keywords

  • Ascorbic acid
  • Corticosteroids
  • Metabolic resuscitation
  • Sepsis
  • Thiamine

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Fingerprint

Dive into the research topics of 'Ascorbic acid, corticosteroids, and thiamine in sepsis: a review of the biologic rationale and the present state of clinical evaluation'. Together they form a unique fingerprint.

Cite this