ESICM LIVES 2020

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Abstract

Introduction: Patients with septic shock have a very high mortality rate despite of aggressive treatment in intensive care unit (ICU). Prognosis of oncohaematological patients is even worse. High dose vitamin C therapy received a lot of attention over the last years as a supplementary therapy which could lead to improvement during septic shock. Objective(s): The aim of our study was to evaluate the impact of high dose vitamin C therapy during septic shock in oncohaematological patients. Method(s): We retrospectively analysed data of oncohaematological patients with septic shock who were admitted to the 3rd Intensive care unit from 13 07 2017 to 19 02 2019 in Vilnius university hospital Santaros clinics. Inclusion criteria were: oncohaematological malignancy, age > 18 years, septic shock, arterial or central line inserted, signed informed consent form. Sepsis and septic shock were defined as per SEPSIS-3 definition. When noradrenaline dose reached 0,1 mcg/kg/ min. patients received vitamin C 1500 mg every six hours i/v together with hydrocortisone 50 mg every six hours i/v, thiamine 200 mg i/v once per day supplementary to the standard treatment of septic shock according to local practice. Control group consisted of oncohaematological patients with septic shock who didn't receive high dose vitamin C therapy. High dose vitamin C therapy was stopped when patients became haemodynamically stable. Statistical analysis was performed with R statistical package. A p-value less than 0.05 was considered to be statistically significant. Result(s): 71 patients with haematological malignancies were admitted to ICU. 36 patients were diagnosed with sepsis and 33 of them had septic shock. 23 patients received high dose Vitamin C therapy. 9 patients were excluded from the analysis due to the violation of dosage of vitamin C. Final analysis included 14 patients who received high dose vitamin C therapy. Control group consisted of 10 patients. Patients in high dose vitamin C group were older (65,57 vs 53,95, p < 0.0027), they had a higher SOFA score on day1, day2 and day3 in intensive care unit (accordingly 8,64 vs 6,2*, 10,62 vs 7,12**, 10,09 vs 5,92***, p value *- 0.0534, ** - 0.0051, *** - 0.002597). Arterial pH, BE, lactate did not differ between groups on arrival to intensive care unit (accordingly 7.46 vs 7,43 (p = 0,44), BE -2,99 vs 0,53 (p = 0,48), lactate 1,9 vs 1,2 (p = 0.09)). Intensive care unit survival of patients treated with high dose vitamin C therapy was 21,43% (3/14) compared with 47,37% (9/19) in standard treatment group (p value 0.1258). There was no difference in terms of intravenous fluids (per hour), time spent in intensive care unit, length of vasopressor therapy and renal replacement therapy between the groups (149.15 ml vs 131,1 ml, 69,5 h vs 71 h, 62 h vs 10 h and 50% (7/7) vs 26,32% (5/19)). Conclusion(s): High dose vitamin C therapy didn't improve survival of oncohaematological patients with septic shock. Patients with high dose vitamin C had higher SOFA scores on the first, second and third days in intensive care unit. 03. AIDS, hematologic-oncologic issues in the ICU > AIDS, hematologic- oncologic issues in the ICU.

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ESICM LIVES 2020. (2020). Intensive Care Medicine Experimental, 8(S2). https://doi.org/10.1186/s40635-020-00354-8

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