LAUSR

Learning Objectives: Septic shock remains one of the leading causes of intensive care unit (ICU) associated death, with mortality rates of 30-50%. A study conducted by Marik, et al. found that early intervention with intravenous (IV) ascorbic acid, thiamine, & hydrocortisone was effective at reducing vasopressor requirements and mortality in patients with septic shock. The purpose of this study was to evaluate if administering this regimen to patients in septic shock reduced ICU mortality. Methods: This Institutional Review Board approved retrospective cohort study was conducted at a 607 bed teaching hospital in New Jersey from May 2017 to February 2018. Patients were included who were ≥ 18 years of age, diagnosed with septic shock, and required > one vasopressor to target a mean arterial pressure of ≥ 65 mmHg. Patients were incorporated into the treatment group after initiating three IV agents (ascorbic acid 1.5g every 6 hours, hydrocortisone 50mg every 6 hours, & thiamine 200mg every 12 hours) for at least four days or until ICU discharge. Patients were excluded if only one vasopressor was initiated. The primary objective of this study was to investigate ICU mortality. Secondary objectives included the number of vasopressors required, ICU length of stay (LOS), and duration of mechanical ventilation (MV). Results: 300 patient charts were screened for inclusion. After applying inclusion and exclusion criteria, 172 patients were included. The remaining 128 patients were excluded because one vasopressor was administered. There was no difference observed in ICU mortality (58.1% vs. 61.8%; p = 0.738). The mean number of vasopressors used in each group was 2.5. Patients in the treatment group were admitted in the ICU for an average of 5.96 ± 5.91. The control group had a LOS of 6.00 days ± 6.17 days. The mean duration of MV in the treatment group was 3.30 ± 5.58 days compared to the control group which required 3.45 days ± 6.19 days. Conclusions: Patients who received the combination of IV ascorbic acid, thiamine, & hydrocortisone failed to show a statistically significant decrease in ICU mortality over the control group. The initial study investigating this regimen included patients prior to initiation of vasopressors, and only 46% of patients required vasopressor therapy. Meanwhile, a requirement to be included in this study was initiation of > 1 vasopressor, demonstrating a higher severity of illness. Further research is needed to investigate the efficacy of this regimen prior to progression to septic shock.