Another Trial Shows No Benefit of Vitamin C, Thiamine, and Hydrocortisone in Sepsis

In 2017, treating patients who had sepsis and septic shock with vitamin C, thiamine, and glucocorticoids became the hottest topic of discussion in critical care. A single center reported remarkably lower mortality in patients treated with these medications (NEJM JW Gen Med Aug 15 2017 and Chest 2017; 151:1229). Since that time, multiple randomized controlled trials have failed to demonstrate the same effect (NEJM JW Gen Med Dec 15 2019 and JAMA 2019; 322:1261; NEJM JW Gen Med Feb 15 2020 and JAMA 2020; 323:423).

In this multisite U.S. trial, investigators randomized patients with sepsis-induced respiratory or cardiovascular dysfunction to intravenous vitamin C, thiamine, and hydrocortisone (1.5 g, 100 mg, and 50 mg, respectively, given every…