Sepsis resuscitation generally focuses on hemodynamics. Rivers of ink have been spilled writing about oxygen delivery and fluid responsiveness. This is clearly important, but it's possible that our focus on easily observable phenomena has led us to ignore something of equal importance: metabolic resuscitation. We can deliver all the oxygen we want to the tissues, but if the mitochondria are failing it won't work.

Clinical practice isn't scientifically perfect. Nearly all of our current therapies for sepsis lack level-I evidence. On the front lines of critical care, we are forced to treat dying patients based on the evidence that we have, not the evidence that we might wish for. In the context of this imperfect reality, treating septic patients with Vitamin C and thiamine may be a rational and evidence-based practice. Indeed, some authors recommended using IV vitamin C even before Marik's study was released.

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