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Recent publications on vitamin C have focused on the rise of its use in the treatment of the critically ill. The search for the best treatment or the best adjuvant treatment for patients in a refractory situation is a primary objective of these. Despite good initial results and a pathophysiological basis, the efficiency of vitamin C treatments has not been conclusively proven in recent randomized clinical trials. This has meant that the Surviving Sepsis Campaign does not recommend its use. Therefore, although we do not expect vitamin C to be used by a majority of survey respondents, we do expect it to be used in refractory septic shock or have some relevance in local protocols on management of septic shock.
In this survey we also examine how vitamin C is being used to treat critically ill patients with other conditions; there is often less evidence available in these situations, however, we consider that since the pathophysiological basis is the same, the information gathered may lead us to propose future randomized studies on other types of non-septic critical patients.
This survey, endorsed by ESICM, will enable us to understand the impact of the use of vitamin C as an adjunctive treatment for the inflamed critically ill patient, as well as for other critically ill patients (those with ARDS, severe pneumonia due to SARS-CoV-2). The results will help us to explore the possibility of conducting multicenter studies on the use of vitamin C in the future. Thank you very much for participating.
The Vit-C survey team: Luis Chiscano–Camón (survey Lead, Vall d'Hebron Hospital, Barcelona, Spain), Ricard Ferrer Roca, Juan Carlos Ruiz Rodriguez, Mette M. Berger, Elke Gunnar, Pedro Povoa.

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* 1. Contact name (optional)

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* 2. Contact email (optional)

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* 3. What is the name of your institution (optional)

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* 4. In what city/town do you work (Main activity)

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* 6. what is the type of institution you work in?

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* 7. Number of beds in your institution:

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* 8. Catchment area population:

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* 9. Critically septic patients are generally admitted to:

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* 10. What is the number of septic patients admitted to ICU / year?

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* 11. What medical specialty do you belong to?

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* 12. What is the type of patient admitted to your unit?

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* 13. Does the service have its own protocol for treating septic patients according to the standard of care?

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* 14. Does the service have its own protocol for treating different clinical situations (postoperative, non-septic shock, ARDS, etc.) according to the recent standard of care?

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* 15. How familiar are you with the existing body of published evidence on vitamin C in patients with septic shock?

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* 16. What elements of the published clinical trials of vitamin C in patients with septic shock limit the clinical uptake of this therapy?

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* 17. Do you think that vitamin C has a physiopathological effect on the septic patient?

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* 18. Have you used vitamin C infusion in the subgroup of patients in sepsis or septic shock?

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* 19. In the case of vitamin C use in septic shock patients, do you use it in case of refractoriness to conventional treatment or prior to this situation (e.g.: from the beginning of the shock treatment?

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* 20. In the past year, in how many patients have you prescribed vitamin C as an adjunctive treatment for septic shock?

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* 21. In case of use in septic patients, do you use it supplemented with intravenous infusion of vitamin B1 and corticosteroids at shock doses?

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* 22. What dose of vitamin C do you use?

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* 23. What dose of vitamin B1 do you use?

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* 24. What dose of corticosteroids do you use?

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* 25. How long do you keep vitamin C therapy?

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* 26. Do you make any variation regarding the dose if the patient is undergoing renal replacement therapy?

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* 27. Have you observed any adverse reactions? If yes, what type?

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* 28. Do you measure plasma levels of vitamin C?

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* 29. If so, how long does it take for the results to be available?

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* 30. How are blood samples for vitamin C testing taken?

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* 31. Where is the analysis of plasma levels of vitamin C performed?

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* 32. In the case of determining vit C levels, does it remain without exposure to light and at low temperature?

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* 33. If no to the previous question, what is the method used?

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* 34. Have you used vitamin C in ARDS associated with SARS-CoV-2 in patients undergoing invasive mechanical ventilation?

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* 35. If so, at which stage of SARS-CoV-2 induced ARDS do you use it in patients undergoing invasive mechanical ventilation (following standard of care Berlin – definition)?

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* 36. Do you use vitamin C in COVID-19 pneumonia patients admitted to ICU but without invasive mechanical ventilation?

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* 37. In case of use in SARS-CoV-2 patients, do you use it supplemented with intravenous infusion of vitamin B1 and corticosteroids at shock doses?

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* 38. What dose of vitamin C do you use in the SARS-CoV-2 patient?

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* 39. What dose of vitamin B1 do you use in the SARS-CoV-2 patient?

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* 40. What dose of corticosteroids do you use in the SARS-CoV-2 patient?

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* 41. Do you use vitamin C within the SIRS patient group?

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* 42. In case of use in SIRS patients, do you use it supplemented with intravenous infusion of vitamin B1 and corticosteroids at shock doses?

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* 43. What dose of vitamin C do you use in SIRS patients with dependence on high vasopressor drugs?

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* 44. What dose of vitamin B1 do you use in SIRS patients if you use it as an adjuvant to vitamin C?

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* 45. What dose of corticosteroids do you use in SIRS patients with dependence on high vasopressor drugs?

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* 46. If so, specify in which type of SIRS patients do you use adjuvant treatment with vitamin C:

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* 47. Would you be willing to enroll your patients into a randomized trial of vitamin C in life-threatening infection?

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* 48. What primary outcome would you like to see in a phase 3 trial of vitamin C in septic shock?

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