hospital beds infections

NEJM: Trial of IV Vitamin C for Septic ICU Patients Interview with:
François Lamontagne MD MSc (pharmacology) MSc (CEB)

Professor of Medicine at the Université de Sherbrooke
Endowed research chair on patient-centred research

Dr. Neill Adhikari MDCM, M.Sc.
Sunnybrook Research Institute and University of Toronto
Toronto, Canada  What is the background for this study? 

Response: The use of intravenous vitamin C for sepsis has been a hot topic for a few years. It was biologically plausible that vitamin C could reduce organ injury and death by scavenging reactive oxygen species and modulating the immune response to sepsis. It also seemed like an intervention that would be reasonably easy to administer globally should it prove beneficial. On the other hand, no intervention is benign and every aspect of health care should be rigorously studied. Regarding vitamin C, there were strongly held opinions in both camps and this motivated us to design and conduct the LOVIT trial.  What are the main findings?

Response: The main findings were that in adults with sepsis who were receiving vasopressor therapy in the ICU, the receipt of intravenous vitamin C resulted in a higher risk of death or persistent organ dysfunction at 28 days than the receipt of placebo. What should readers take away from your report?

Response: The surest and fastest route to helping patients is via highly rigorous research. In the face of uncertainty, strongly held opinions by clinicians is a real deterrent to optimal care. Research and health care should not exist in separate silos. The seamless integration of research activities in routine health care should be a priority for all health systems in order to facilitate the conduct of efficient and impactful studies. What recommendations do you have for future research as a result of this work?

Response: There have been more than 4000 patients enrolled in small inconclusive trials of vitamin C. Uncertainty and wasted research resources and opportunities similarly affect a very large number of routine interventions across all areas in health care. Collectively, we know how to design and conduct studies that would immediately improve patient care and outcomes. What we lack is coordination, collaboration and broader stakeholder engagement. When those ingredients are present, large trials can be completed rapidly. And, though there is a cost, good research is almost always cost-efficient, when compared to ’no research’. Is there anything else you would like to add?

Response: We are also leading ongoing RCTs of vitamin C for COVID (the LOVIT-COVID trial and the vitamin C domain of the REMAP-CAP Platform trial). More than 2000 patients have been enrolled in these trials, which are monitored by two distinct Data Safety and Monitoring Boards who have recommended that the trials continue. When the results of those trials become available, we may learn whether or not this intervention has a different effect in sepsis caused by the specific viral pathogen SARS-CoV2. 


Intravenous Vitamin C in Adults with Sepsis in the Intensive Care Unit

François Lamontagne, M.D., Marie-Hélène Masse, M.Sc., Julie Menard, Ph.D., Sheila Sprague, Ph.D., Ruxandra Pinto, Ph.D.,
Daren K. Heyland, M.D., Deborah J Cook, M.D., Marie-Claude Battista, Ph.D., Andrew G. Day, M.Sc., Gordon H. Guyatt, M.D., Salmaan Kanji, Pharm.D., Rachael Parke, R.N., M.H.Sc., Ph.D.,  for the LOVIT Investigators and the Canadian Critical Care Trials Group
June 15, 2022
DOI: 10.1056/NEJMoa2200644

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Last Updated on June 15, 2022 by Marie Benz MD FAAD