Vitamin C in critical illness has always hinted at more than scurvy’s salvation. From Lind’s lemons to Linus Pauling’s promise to an ICU cocktail that briefly looked like a cure, the arc swings between elegant biology and stubborn clinical reality. We track the enzymes and endothelium, the catecholamines and carnitine, and the redox alchemy that can both shield and scorch. Then we meet the trials—VITAMINS neutral, LOVIT unnerving—and ask why sepsis would not yield while burns, post-arrest care, and megadose strategies still tempt inquiry. This piece follows the CCR thread through Belfast to Melbourne, where VITaCCA may yet decide whether our romance with ascorbate is requited or finally unmasked.

Added October 16th

Induction for rapid sequence intubation (RSI) in the critically ill often feels like the swing of a pendulum. Toward etomidate—haemodynamic poise, clean hypnosis, and familiar dosing. Back toward ketamine—sympathomimetic support, bronchodilation, and neuro-myths in slow retreat. The science, at times, looks just as mercurial. This review examines the terrain with a steady eye: what goes wrong when we intubate the critically ill; why physiology, not just anatomy, governs risk; what etomidate and ketamine truly offer; what the best comparative trials show; and where ongoing research is taking the field.

Added September 4th

We review the RE-ENERGIZE trial, investigating glutamine for patient's with severe burns, and seek to understand why the trial failed to identify benefit. Was it a methodological failure, a flawed execution, or a correct identification of a non-beneficial intervention?

Added December 20th, 2023

The Fragility Index is the minimum number of subjects whose status would have to change from a non-event to an event to convert a statistically significant result of the trial into a non-significant result. It is an expression of the study characteristics, and not of validity.

Guest post by Dr Ed Palmer

Added August 21st, 2022

Why did the REST trial¹ fail to clearly demonstrate benefit with the addition of an ECCO₂R  device in invasively mechanically ventilated patients with acute hypoxaemic respiratory failure?

Added October 4th, 2021