Vitamin C and COVID-19 , plus Vitamin C and Vitamin D for ARDS

In an article published in the Chinese Journal of Infection Diseases, the Shanghai Medical Association endorsed the use of high dose vitamin C as a treatment for hospitalized people with COVID-19 ( 10 ).

Doses that are magnitudes higher than the DV are recommended to be given through IV to improve lung function, which may help keep a patient off of mechanical ventilation or life support ( 10 ,   11 Trusted Source ,   12 Trusted Source ).

Additionally, a 2019 review found that both oral and IV high dose vitamin C treatment may aid people admitted to intensive care units (ICUs) for critical illnesses by reducing ICU stay length by 8% and shortening the duration of mechanical ventilation by 18.2% ( 13 Trusted Source ).

Chinese researchers have also registered a clinical trial to further study the effectiveness of IV vitamin C in hospitalized people with COVID-19 ( 14 ).

12. Ann Intensive Care . 2018; 8: 3.  

Published online 2018 Jan 10.   doi:  10.1186/s13613-017-0350-x

PMCID:   PMC5768582

PMID:   29330690

Extracorporeal membrane oxygenation for severe Middle East respiratory syndrome coronavirus

Ab. Middle East respiratory syndrome (MERS) is caused by a coronavirus (MERS ‐ CoV) and is characterized by hypoxemic respiratory failure. The objective of this study is to compare the outcomes of MERS-CoV patients before and after the availability of extracorporeal membrane oxygenation (ECMO) as a rescue therapy in severely hypoxemic patients who failed conventional strategies. Outcome

Compared to the control group, the ECMO group had significantly lower in-hospital mortality (65 vs. 100%;   P  = 0.02), longer ICU stay (25 vs. 8 days;   P  = 0.001) (Table  5   and Fig.  1 ). Less use of norepinephrine at days 1 and 14 ( P  < 0.05), and better oxygenation (higher PaO 2 /FiO 2   ratio) throughout days 7–14 (Table  2 ).

Nutrients . 2019 Apr; 11(4): 708.   Published online 2019 Mar 27.   doi:  10.3390/nu11040708

PMCID:   PMC6521194

PMID:   30934660

Vitamin C Can Shorten the Length of Stay in the ICU: A Meta-Analysis (PubMed)

Harri Hemilä 1,*   and    Elizabeth Chalker 2

A number of controlled trials have previously found that in some contexts, vitamin C can have beneficial effects on blood pressure, infections, bronchoconstriction, atrial fibrillation, and acute kidney injury. However, the practical significance of these effects is not clear. The purpose of this meta-analysis was to evaluate whether vitamin C has an effect on the practical outcomes: length of stay in the intensive care unit (ICU) and duration of mechanical ventilation. We identified 18 relevant controlled trials with a total of 2004 patients, 13 of which investigated patients undergoing elective cardiac surgery. We carried out the meta-analysis using the inverse variance, fixed effect options, using the ratio of means scale. In 12 trials with 1766 patients, vitamin C reduced the length of ICU stay on average by 7.8% (95% CI: 4.2% to 11.2%;  p  = 0.00003). In six trials, orally administered vitamin C in doses of 1–3 g/day (weighted mean 2.0 g/day) reduced the length of ICU stay by 8.6% ( p  = 0.003). In three trials in which patients needed mechanical ventilation for over 24 hours, vitamin C shortened the duration of mechanical ventilation by 18.2% (95% CI 7.7% to 27%;  p  = 0.001).

https://www.mdpi.com/2072-6643/11/4/708

N Y Hospital uses vitamin C effectively in treating Coronavirus-

https://www.nutraingredients.com/Article/2020/03/25/Hospital-turns-to-high-dose-vitamin-C-to-fight-coronavirus

(patients who received vitamin C did significantly better)

The Shanghai Medical Association & Gov’t has endorsed High Dose Vit C IV for treatment of CV- https://mp.weixin.qq.com/s/bF2YhJKiOfe1yimBc4XwOA

Dr. Cheng states that the principle investigator of the first high-dose IV vitamin C trial in China has told him that the preliminary results of the study are promising. The investigator said the administration of 24 grams per day to COVID-19 patients leads to significant reductions in inflammation. Dr. Cheng said this is notable because massive inflammation in the lungs and potentially other organs may be fatal in the illness.

https://www.medicinenet.com/coronavirus_covid-19_sars_cov_2_news_updates/article.htm

 

IV Vit C was effective in use for ARDS-

World J Crit Care Med . 2017 Feb 4; 6(1): 85–90.  

Published online 2017 Feb 4.   doi:  10.5492/wjccm.v6.i1.85

PMCID:   PMC5295174

PMID:   28224112

Intravenous vitamin C as adjunctive therapy for enterovirus/rhinovirus induced acute respiratory distress syndrome

Alpha A Fowler III ,   et al, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5295174/

  Infusing high dose intravenous   vitamin C   into this patient with virus-induced   ARDS   was associated with rapid resolution of lung injury with no evidence of post- ARDS   fibroproliferative sequelae. Intravenous   vitamin C   as a treatment for   ARDS   may open a new era of therapy for   ARDS   from many causes.

 


Nutrients.   2020 Apr 2;12(4). pii: E988. doi: 10.3390/nu12040988.

Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths.

Grant WB 1 et al - https://www.ncbi.nlm.nih.gov/pubmed/32252338

 


Rev Esp Anestesiol Reanim.   2020 Apr 14. pii: S0034-9356(20)30075-X. doi: 10.1016/j.redar.2020.03.004. [Epub ahead of print]

Two known therapies could be useful as adjuvant therapy in critical patients infected by COVID-19.

[ Article in English, Spanish] (Vitamin C IV & Ozone), Hernández A 1 et al

https://www.ncbi.nlm.nih.gov/pubmed/32303365

 

J Antimicrob Chemother . 2003 Dec; 52(6): 1049–1050.  

Published online 2003 Dec.   doi:  10.1093/jac/dkh002 PMCID:   PMC7110025 , PMID:   14613951

Vitamin C and SARS coronavirus

Harri Hemilä - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7110025/

vitamin C increased the resistance of chick embryo tracheal organ cultures to infection caused by an avian coronavirus. 4 Studies in animals found that vitamin C modifies susceptibility to various bacterial and viral infections, 3  for example protecting broiler chicks against an avian coronavirus. 5 Placebo-controlled trials have shown quite consistently that the duration and severity of common cold episodes are reduced in the vitamin C groups, 3  indicating that viral respiratory infections in humans are affected by vitamin C levels. There is also evidence indicating that vitamin C may affect pneumonia. 3  In particular, three controlled trials with human subjects reported a significantly lower incidence of pneumonia in vitamin C-supplemented groups, 6  suggesting that vitamin C may affect susceptibility to lower respiratory tract infections under certain conditions.

 

  Hemilä, H. & Douglas, R. M. (1999). Vitamin C and acute respiratory infections. International Journal of Tuberculosis and Lung Diseases 3, 756–61. [ PubMed ]


Zhonghua Wei Zhong Bing Ji Jiu Yi Xue.   2020 Jan;32(1):1-7. doi: 10.3760/cma.j.cn121430-20191213-00001.

[Breakthroughs in global critical care medicine 2019]. - https://www.ncbi.nlm.nih.gov/pubmed/32148223

[Article in Chinese]

Huang W 1 ,   Qin Y ,   Dai X . - https://www.ncbi.nlm.nih.gov/pubmed/32148223

many significantly important trials with positive results: high dose  vitamin C  for septic shock,

 

Inflammation.   2019 Oct;42(5):1585-1594. doi: 10.1007/s10753-019-01020-2.

The Protection Potential of Antioxidant Vitamins Against Acute Respiratory Distress Syndrome: a Rat Trial.

Erol N 1 , - https://www.ncbi.nlm.nih.gov/pubmed/31081527

 ALA, VITE, VITC, and both dose of MP significantly decreased the cytokine levels.


Surg Infect (Larchmt).   2018 Nov/Dec;19(8):812-820. doi: 10.1089/sur.2018.111. Epub 2018 Jul 24.

Patterns of Death in Patients with Sepsis and the Use of Hydrocortisone,   Ascorbic Acid , and Thiamine to Prevent These Deaths.

Marik PE 1 . - https://www.ncbi.nlm.nih.gov/pubmed/30040533


BMJ Case Rep.   2018 Feb 2;2018. pii: bcr-2017-223475. doi: 10.1136/bcr-2017-223475.

ARDS   complicating pustular psoriasis: treatment with low-dose corticosteroids,   vitamin C   and thiamine.

Marik PE 1 ,   Long A 1 . https://www.ncbi.nlm.nih.gov/pubmed/29420246-

 patient made a dramatic recovery being weaned to nasal cannulae within 24 hours after the initiation of this treatment protocol and was discharged home a few days later.


Ann Surg.   2002 Dec;236(6):814-22.

Randomized, prospective trial of antioxidant supplementation in critically ill surgical patients.

Nathens AB 1 ,   et al-- https://www.ncbi.nlm.nih.gov/pubmed/12454520

 

The early administration of antioxidant supplementation using alpha-tocopherol and ascorbic acidreduces the incidence of organ failure and shortens ICU length of stay in this cohort of critically ill surgical patients.


Int J Mol Sci.   2020 Feb 1;21(3). pii: E977. doi: 10.3390/ijms21030977.

Dietary Antioxidants Significantly Attenuate Hyperoxia-Induced Acute Inflammatory Lung Injury by Enhancing Macrophage Function via Reducing the Accumulation of Airway HMGB1.

Patel V 1. https://www.ncbi.nlm.nih.gov/pubmed/32024151

dietary antioxidants,   ascorbic acid   and sulforaphane, ameliorate HALI and attenuate hyperoxia-induced macrophage dysfunction through an HMGB1-mediated pathway.

 

Sepsis


J Thorac Dis.   2020 Feb;12(Suppl 1):S84-S88. doi: 10.21037/jtd.2019.12.64.

Vitamin C : an essential "stress hormone" during   sepsis .

Marik PE 1 . - https://www.ncbi.nlm.nih.gov/pubmed/32148930

reatment with  vitamin C appears to restore the stress response and improve the survival of stressed humans.


J Intensive Care.   2020 Feb 7;8:15. doi: 10.1186/s40560-020-0432-y. eCollection 2020.

Vitamin C   may reduce the duration of mechanical ventilation in critically ill patients: a meta-regression analysis.

Hemilä H 1 ,   Chalker E 2 . https://www.ncbi.nlm.nih.gov/pubmed/32047636

We found strong evidence that  vitamin C  shortens the duration of mechanical ventilation,


J Trauma Acute Care Surg.   2020 Feb 7. doi: 10.1097/TA.0000000000002613. [Epub ahead of print]

Vitamin C   and Thiamine Are Associated with Lower Mortality in Sepsis.

Byerly S - https://www.ncbi.nlm.nih.gov/pubmed/32039973

VitC+THMN is associated with increased survival in septic ICU patients

NAC.
Hum Exp Toxicol.   2007 Sep;26(9):697-703.

Improvement by N-acetylcysteine of acute respiratory distress syndrome through increasing intracellular glutathione, and extracellular thiol molecules and anti-oxidant power: evidence for underlying toxicological mechanisms.

Soltan-Sharifi MS 1. https://www.ncbi.nlm.nih.gov/pubmed/17984140

patients with   ARDS   are in a deficient oxidant-anti-oxidant balance that can get a significant benefit if supplemented with NAC.

 

January 1994 Volume 105, Issue 1, Pages 190–194  

N-Acetylcysteine Enhances Recovery From Acute Lung Injury in Man

A Randomized, Double-Blind, Placebo-Controlled Clinical Study

Peter M. Suter, et al; https://journal.chestnet.org/article/S0012-3692(15)43843-7/abstract

 

Vit D


Biochem Pharmacol.   2020 Apr 3:113955. doi: 10.1016/j.bcp.2020.113955. [Epub ahead of print]

Vitamin D attenuates lung injury via stimulating epithelial repair, reducing epithelial cell apoptosis and inhibits TGF-β induced epithelial to mesenchymal transition.

Zheng S 1 ,


Nutrients.   2020 Apr 2;12(4). pii: E988. doi: 10.3390/nu12040988.

Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths.

Grant WB 1 , et al; https://www.ncbi.nlm.nih.gov/pubmed/32252338

 


BMJ Open Respir Res.   2015 Jun 13;2(1):e000074. doi: 10.1136/bmjresp-2014-000074. eCollection 2015.

Association between prehospital vitamin D status and incident acute respiratory failure in critically ill patients: a retrospective cohort study. Thickett DR 1 ,   ET AL- https://www.ncbi.nlm.nih.gov/pubmed/26113982

Compared to patients with 25(OH)D ≥30 ng/mL, patients with lower 25(OH)D levels had significantly higher adjusted odds of acute respiratory failure 

 


Inflamm Allergy Drug Targets.   2013 Aug;12(4):253-61.

Vitamin D deficiency and acute lung injury.

Parekh D 1 - https://www.ncbi.nlm.nih.gov/pubmed/23782208

The evidence for the role of vitamin D in lung disease is growing - deficiency has been associated with impaired pulmonary function, increased incidence of viral and bacterial infections and inflammatory disease including asthma and COPD. Studies have also reported a high prevalence of vitamin D deficiency in the critically ill and an association with adverse outcomes.