No Benefit to Hydrocortisone, Thiamine, and Vitamin C for Patients with Septic Shock

Should patients with sepsis be treated with hydrocortisone, vitamin C, and thiamine? This question has been debated since publication of dramatically lower mortality after adoption of this practice at a hospital in Virginia (NEJM JW Gen Med Aug 15 2017 and Chest 2017; 151:1199).

To test these results, investigators from Australia, Brazil, and New Zealand randomized 211 septic patients on vasopressors for at least 2 hours to receive either hydrocortisone (50 mg every 6 hours) alone or in combination with vitamin C (1.5 g every 6 hours) and thiamine (200 mg every 12 hours). Patients were enrolled within 24 hours of diagnosis of septic shock; about half of patients came from the emergency department. The median time to vitamin C was 12 hours an…