The Effect of Combination Therapy with Hydrocortisone+ Ascorbic Acid+ Neurobion on the Prognosis of Multiple Trauma Patients

Document Type : Original Article(s)

Authors

1 Assistant Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical sciences, Isfahan, Iran

3 Resident of Anesthesiology, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Inflammatory responses are one the factors influencing the prognosis of multiple trauma patients. Hydrocortisone, with an appropriate dose, diminishes the inflammatory responses without immunosuppression, improving the patients’ immune system. Administering vitamins specifically vitamin B and C to multiple trauma patients, by eliminating free radicals, could decrease the mortality of these patients. This study was done to evaluate the efficacy of treatment with a combination of Hydrocortisone+ Ascorbic acid+ Neurobion (vitB1+B6+B12) on the prognosis of multiple trauma patients hospitalized in Intensive Care Units.
Methods: In a three-blind clinical trial study, 60 multiple trauma patients randomly allocated to two groups of intervention and control. In the intervention group, the patients received 1.5g vitamin C every 6 hours for a period of 4 days, Hydrocortisone 50 mg every 6 hours for a period of 7 days, two Neurobion every 12 hours for 4 days. In the control group, the patients received placebo. The patients in both groups were followed for ninety days and eventually, length of ICU stay, the need for mechanical ventilation and duration of mechanical ventilation were determined and compared between the two groups.
Findings: The mean duration of mechanical ventilation in the intervention and control group were 8.96 ± 6.03 and 14.8 ± 8.11 respectively which was statistically significant. There were no significant differences between the two groups in other outcome measures.
Conclusion: Our study shows administration of combination of Hydrocortisone+ Ascorbic acid+ Neurobion (vitB1+B6+B12) could decrease the duration of mechanical ventilation in multiple trauma patients.

Keywords

Main Subjects

References

  1. van Breugel JM, Niemeyer MJ, Houwert RM, Groenwold RH, Leenen LP, van Wessem KJ. Global changes in mortality rates in polytrauma patients admitted to the ICU—a systematic review. World J Emerg Surg 2020; 15(1): 55.
  2. Bouras M, Roquilly A, Mahé PJ, Cinotti R, Vourc’h M, Perrot B, et al. Cortisol total/CRP ratio for the prediction of hospital-acquired pneumonia and initiation of corticosteroid therapy in traumatic brain-injured patients. Crit Care 2019; 23(1): 394.
  3. Asehnoune K, Vourc’h M, Roquilly A. Hormone therapy in trauma patients. Crit Care Cli 2019; 35(2): 201-11.
  4. Megahed M, Habib T, Ahmed I, Hefnawy M. Early hydrocortisone for multiple trauma patients may lower the incidence of nosocomial pneumonia. Res Opin Anesth Intensive Care 2018; 5(2): 115-9.
  5. Parker R, Rice MJ. Benefits of antioxidant supplementation in multi-trauma patients: Rom J Anaesth Intensive Care 2015; 22(2): 77-8.
  6. Spoelstra-de Man AME, Oudemans-van Straaten HM, Elbers PWG. Vitamin C and thiamine in critical
    BJA Educ 2019; 19(9): 290-6
  7. Colliou E, Arnaud M, Delas A, Delarche A, Faguer S. Oxalate nephropathy following vitamin C intake within intensive care unit. Clin Nephrol 2017; 88(12): 354-8.
  8. Fujii T, Luethi N, Young PJ, Frei DR, Eastwood GM, French CJ, et al. Effect 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 trial. JAMA 2020; 323(5): 423-31.
  9. Romain M, Sviri S, Linton DM, Stav I, van Heerden PV. The role of vitamin B12 in the critically ill—a review. Anaesth Intensive Care 2016; 44(4): 447-52.
  10. Giustina AD, Danielski LG, Novochadlo MM, Goldim MP, Joaquim L, Metzker KL, et al. Vitamin B6 reduces oxidative stress in lungs and liver in experimental sepsis. An Acad Bras Cienc 2019; 91(4): e20190434
  11. Marik PE, Khangoora V, Rivera R, Hooper MH, Catravas J. Hydrocortisone, Vitamin C, and Thiamine for the treatment of severe sepsis and septic shock: A retrospective before-after study. Chest 2017; 151(6): 1229-38.
  12. Cairo JM. Pilbeam's mechanical ventilation: physiological and clinical applications. 6th USA: Elsevier Health Sciences; 2015.
  13. Marik PE. Hydrocortisone, ascorbic acid and thiamine (hat therapy) for treatment of sepsis. Focus
    on ascorbic acid. Nutrients 2018; 10(11): 1762.
  14. Zayed Y, Alzghoul BN, Banifadel M, Venigandla H, Hyde R, Sutchu S, et al. Vitamin C, thiamine, and hydrocortisone in the treatment of sepsis: a meta-analysis and trial sequential analysis of randomized controlled trials. J Intensive Care Med 2022; 37(3): 327-36.
Journal of Isfahan Medical School
Volume 41, Issue 707
3rd Week, April
March and April 2023
Pages 62-68

Files

History

  • Receive Date: 09 November 2022
  • Accept Date: 09 April 2023

Share

How to cite

Statistics