• Alessandro Putzu, Anne-Marie Daems, Juan Carlos Lopez-Delgado, Vito Federico Giordano, and Giovanni Landoni.
• Division of Anesthesiology, Department of Anesthesiology, Pharmacology & Intensive Care Medicine, Geneva University Hospitals, Geneva, Switzerland.
• Crit. Care Med. 2019 Jun 1; 47 (6): 774-783.

ObjectivesThe effects of vitamin C administration on clinical outcome in critically ill patients remain controversial.Data SourcesOnline databases were searched up to October 1, 2018.Study SelectionWe included randomized controlled trials on the use of vitamin C (any regimen) in adult critically ill patients versus placebo or no therapy.Data ExtractionRisk ratio for dichotomous outcome and standardized mean difference for continuous outcome with 95% CI were calculated using random-effects model meta-analysis.Data SynthesisForty-four randomized studies, 16 performed in ICU setting (2,857 patients) and 28 in cardiac surgery (3,598 patients), published between 1995 and 2018, were included in the analysis. In ICU patients, vitamin C administration was not associated with a difference in mortality (risk ratio, 0.90; 95% CI, 0.74-1.10; p = 0.31), acute kidney injury, ICU or hospital length of stay compared with control. In cardiac surgery, vitamin C was associated to a reduction in postoperative atrial fibrillation (risk ratio, 0.64; 95% CI, 0.52-0.78; p < 0.0001), ICU stay (standardized mean difference, -0.28 d; 95% CI, -0.43 to -0.13 d; p = 0.0003), and hospital stay (standardized mean difference, -0.30 d; 95% CI, -0.49 to -0.10 d; p = 0.002). Furthermore, no differences in postoperative mortality, acute kidney injury, stroke, and ventricular arrhythmia were found.ConclusionsIn a mixed population of ICU patients, vitamin C administration is associated with no significant effect on survival, length of ICU or hospital stay. In cardiac surgery, beneficial effects on postoperative atrial fibrillation, ICU or hospital length of stay remain unclear. However, the quality and quantity of evidence is still insufficient to draw firm conclusions, not supporting neither discouraging the systematic administration of vitamin C in these populations. Vitamin C remains an attractive intervention for future investigations aimed to improve clinical outcome.

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