Critical Care Controversies! Vitamin C+Thiamine+Hydrocortisone for Severe Sepsis and Septic Shock

Study design: Retrospective "Before and After" study


Patient inclusion/Exclusion:





  • The intervention group received standard sepsis care + the experimental package below, while the "before" control group received standard sepsis care + steroid therapy at the discretion of the treating physician (59.6%)










  • Not an RCT (with possible attendant selection bias)
  • Not blinded (did the treatment group do so much better with more intensive care provided by investigators?)
  • Small numbers (47 in each group)
  • Single center study



You should review the original article here:


For a fantastic review of the topic, check out this PulmCrit article which includes an embedded video discussion of the paper by the author:

Be sure to scroll down to the bottom to see some of the rather heated discussion in the comments section!


And for extra credit, check out this scathing letter written by the lead author to CMS regarding sepsis management guidelines: