Reduction of Resuscitation Fluid Volumes in Severely Burned Patients Using Ascorbic Acid Administration
Top Cited Papers
Open Access
- 1 March 2000
- journal article
- clinical trial
- Published by American Medical Association (AMA) in Archives of Surgery
- Vol. 135 (3), 326-331
- https://doi.org/10.1001/archsurg.135.3.326
Abstract
Hypothesis High-dose ascorbic acid (vitamin C) therapy (66 mg/kg per hour) attenuates postburn lipid peroxidation, resuscitation fluid volume requirements, and edema generation in severely burned patients. Study Design and Setting A prospective, randomized study at a university trauma and critical care center in Japan. Subjects and Methods Thirty-seven patients with burns over more than 30% of their total body surface area (TBSA) hospitalized within 2 hours after injury were randomly divided into ascorbic acid and control groups. Fluid resuscitation was performed using Ringer lactate solution to maintain stable hemodynamic measurements and adequate urine output (0.5-1.0 mL/kg per hour). In the ascorbic acid group (n=19; mean burn size, 63% ± 26% TBSA; mean burn index, 57 ± 26; inhalation injury, 15/19), ascorbic acid was infused during the initial 24-hour study period. In the control group (n=18; mean burn size, 53% ± 17% TBSA; mean burn index, 47 ± 13; inhalation injury, 12/18), no ascorbic acid was infused. We compared hemodynamic and respiratory measurements, lipid peroxidation, and fluid balance for 96 hours after injury. Two-way analysis of variance and Tukey test were used to analyze the data. Results Heart rate, mean arterial pressure, central venous pressure, arterial pH, base deficit, and urine outputs were equivalent in both groups. The 24-hour total fluid infusion volumes in the control and ascorbic acid groups were 5.5 ± 3.1 and 3.0 ± 1.7 mL/kg per percentage of burn area, respectively (P<.01). In the first 24 hours, the ascorbic acid group gained 9.2% ± 8.2% of pretreatment weight; controls, 17.8% ± 6.9%. Burned tissue water content was 6.1 ± 1.8 vs 2.6 ± 1.7 mL/g of dry weight in the control and ascorbic acid groups, respectively (P<.01). Fluid retention in the second 24 hours was also significantly reduced in the ascorbic acid group. In the control group, the ratio of PaO2 to fraction of inspired oxygen at 18, 24, 36, 48, and 72 hours after injury was less than that of the ascorbic acid group (P<.01). The length of mechanical ventilation in the control and ascorbic acid groups was 21.3 ± 15.6 and 12.1 ± 8.8 days, respectively (P<.05). Serum malondialdehyde levels were lower in the ascorbic acid group at 18, 24, and 36 hours after injury (P<.05). Conclusions Adjuvant administration of high-dose ascorbic acid during the first 24 hours after thermal injury significantly reduces resuscitation fluid volume requirements, body weight gain, and wound edema. A reduction in the severity of respiratory dysfunction was also apparent in these patients.Keywords
This publication has 20 references indexed in Scilit:
- Hemodynamic Effects of Delayed Initiation of Antioxidant Therapy (Beginning Two Hours After Burn) in Extensive Third-Degree BurnsJournal of Burn Care & Rehabilitation, 1995
- The Effects of High-Dose Vitamin C Therapy on Postburn Lipid PeroxidationJournal of Burn Care & Rehabilitation, 1993
- Effects of High-Dose Vitamin C Administration on Postburn Microvascular Fluid and Protein FluxJournal of Burn Care & Rehabilitation, 1992
- How Long Do We Need to Give Antioxidant Therapy During Resuscitation When Its Administration is Delayed for Two Hours?Journal of Burn Care & Rehabilitation, 1992
- High-dose vitamin C therapy for extensive deep dermal burnsBurns, 1992
- Reduced Fluid Volume Requirement for Resuscitation of Third-Degree Burns with High-Dose Vitamin CJournal of Burn Care & Rehabilitation, 1991
- Fluorometric determination of total vitamin C in whole blood by high-performance liquid chromatography with pre-column derivatizationJournal of Chromatography B: Biomedical Sciences and Applications, 1984
- Urinary oxalate excretion after large intakes of ascorbic acid in manThe American Journal of Clinical Nutrition, 1981
- Assay for lipid peroxides in animal tissues by thiobarbituric acid reactionAnalytical Biochemistry, 1979
- On the physiological action of ascorbic acid and some related compoundsBiochemical Journal, 1934