Journal
CRITICAL CARE
Volume 22, Issue -, Pages -Publisher
BMC
DOI: 10.1186/s13054-018-2217-4
Keywords
Thiamine; Ascorbic acid; Corticosteroids; Metabolic resuscitation; Sepsis
Categories
Funding
- Open Philanthropy Project
- American Heart Association [15SDG22420010]
- National Institutes of Health [K23GM128005-01, 1K23HL128814-01, UO1HL122989-03]
- KL2/Catalyst Medical Research Investigator Training award from Harvard Catalyst \ The Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, National In [KL2 TR001100]
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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.
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