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dc.contributor.authorTomoko Fujiien_US
dc.contributor.authorNora Luethien_US
dc.contributor.authorPaul J. Youngen_US
dc.contributor.authorDaniel R. Freien_US
dc.contributor.authorGlenn M. Eastwooden_US
dc.contributor.authorCraig J. Frenchen_US
dc.contributor.authorAdam M. Deaneen_US
dc.contributor.authorYahya Shehabien_US
dc.contributor.authorLudhmila A. Hajjaren_US
dc.contributor.authorGisele Oliveiraen_US
dc.contributor.authorAndrew A. Udyen_US
dc.contributor.authorNeil Orforden_US
dc.contributor.authorSamantha J. Edneyen_US
dc.contributor.authorAnna L. Hunten_US
dc.contributor.authorHarriet L. Judden_US
dc.contributor.authorLaurent Bitkeren_US
dc.contributor.authorLuca Cioccarien_US
dc.contributor.authorThummaporn Naorungrojen_US
dc.contributor.authorFumitaka Yanaseen_US
dc.contributor.authorSamantha Batesen_US
dc.contributor.authorForbes McGainen_US
dc.contributor.authorElizabeth P. Hudsonen_US
dc.contributor.authorWisam Al-Bassamen_US
dc.contributor.authorDhiraj Bhatia Dwivedien_US
dc.contributor.authorChloe Peppinen_US
dc.contributor.authorPhoebe McCrackenen_US
dc.contributor.authorJudit Oroszen_US
dc.contributor.authorMichael Baileyen_US
dc.contributor.authorRinaldo Bellomoen_US
dc.contributor.otherGraduate School of Medicineen_US
dc.contributor.otherMelbourne Medical Schoolen_US
dc.contributor.otherInstitut fur Sozial- und Praventivmedizinen_US
dc.contributor.otherWestern Healthen_US
dc.contributor.otherUniversity of New South Wales (UNSW) Australiaen_US
dc.contributor.otherUniversity of Melbourneen_US
dc.contributor.otherWellington Hospital, New Zealanden_US
dc.contributor.otherBarwon Healthen_US
dc.contributor.otherMonash Universityen_US
dc.contributor.otherMedical Research Institute of New Zealanden_US
dc.contributor.otherDeakin Universityen_US
dc.contributor.otherFaculty of Medicine, Siriraj Hospital, Mahidol Universityen_US
dc.contributor.otherUniversitätsSpital Bernen_US
dc.contributor.otherHopital de la Croix-Rousseen_US
dc.contributor.otherAlfred Hospitalen_US
dc.contributor.otherAustin Hospitalen_US
dc.contributor.otherCancer Institute of the State of São Pauloen_US
dc.identifier.citationJAMA - Journal of the American Medical Association. Vol.323, No.5 (2020), 423-431en_US
dc.description.abstract© 2020 American Medical Association. All rights reserved. Importance: It is unclear whether vitamin C, hydrocortisone, and thiamine are more effective than hydrocortisone alone in expediting resolution of septic shock. Objective: To determine whether the combination of vitamin C, hydrocortisone, and thiamine, compared with hydrocortisone alone, improves the duration of time alive and free of vasopressor administration in patients with septic shock. Design, Setting, and Participants: Multicenter, open-label, randomized clinical trial conducted in 10 intensive care units in Australia, New Zealand, and Brazil that recruited 216 patients fulfilling the Sepsis-3 definition of septic shock. The first patient was enrolled on May 8, 2018, and the last on July 9, 2019. The final date of follow-up was October 6, 2019. Interventions: Patients were randomized to the intervention group (n = 109), consisting of intravenous vitamin C (1.5 g every 6 hours), hydrocortisone (50 mg every 6 hours), and thiamine (200 mg every 12 hours), or to the control group (n = 107), consisting of intravenous hydrocortisone (50 mg every 6 hours) alone until shock resolution or up to 10 days. Main Outcomes and Measures: The primary trial outcome was duration of time alive and free of vasopressor administration up to day 7. Ten secondary outcomes were prespecified, including 90-day mortality. Results: Among 216 patients who were randomized, 211 provided consent and completed the primary outcome measurement (mean age, 61.7 years [SD, 15.0]; 133 men [63%]). Time alive and vasopressor free up to day 7 was 122.1 hours (interquartile range [IQR], 76.3-145.4 hours) in the intervention group and 124.6 hours (IQR, 82.1-147.0 hours) in the control group; the median of all paired differences was-0.6 hours (95% CI,-8.3 to 7.2 hours; P =.83). Of 10 prespecified secondary outcomes, 9 showed no statistically significant difference. Ninety-day mortality was 30/105 (28.6%) in the intervention group and 25/102 (24.5%) in the control group (hazard ratio, 1.18; 95% CI, 0.69-2.00). No serious adverse events were reported. Conclusions and Relevance: In patients with septic shock, treatment with intravenous vitamin C, hydrocortisone, and thiamine, compared with intravenous hydrocortisone alone, did not significantly improve the duration of time alive and free of vasopressor administration over 7 days. The finding suggests that treatment with intravenous vitamin C, hydrocortisone, and thiamine does not lead to a more rapid resolution of septic shock compared with intravenous hydrocortisone alone.en_US
dc.rightsMahidol Universityen_US
dc.titleEffect of Vitamin C, Hydrocortisone, and Thiamine vs Hydrocortisone Alone on Time Alive and Free of Vasopressor Support among Patients with Septic Shock: The VITAMINS Randomized Clinical Trialen_US
dc.typeConference Paperen_US
Appears in Collections:Scopus 2020

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