Antioxidant Vitamins Improve Surgical Outcomes

Laurie Barclay, MD

December 20, 2002

Dec. 20, 2002 -- Supplementing critically ill surgical patients with antioxidant vitamins C and E reduced risk of organ failure, ventilator support, and length of intensive care unit (ICU) stay, according to the results of a randomized, prospective trial published in the December issue of the Annals of Surgery.

"Oxidative stress has been associated with the development of the acute respiratory distress syndrome (ARDS) and organ failure through direct tissue injury and activation of genes integral to the inflammatory response," write Avery B. Nathens, MD, from the University of Washington, and colleagues. "In addition, depletion of endogenous antioxidants has been associated with an increased risk of nosocomial infections."

Of 595 patients enrolled in this study, 91% were victims of trauma. Compared with patients receiving standard care, those who received antioxidant supplementation with alpha-tocopherol and ascorbate had a shorter duration of mechanical ventilation and length of ICU stay, and lower relative risk (RR) of pulmonary morbidity (RR, 0.81; 95% confidence interval [CI], 0.60 - 1.1) and of multiple organ failure (RR, 0.43; 95% CI, 0.19 - 0.96).

Study limitations include homogeneity of the study population, which prevents generalizability of the results, lack of placebo, and lack of blinding of the investigators, potentially introducing bias.

"The early administration of antioxidant supplementation using alpha-tocopherol and ascorbic acid reduces the incidence of organ failure and shortens ICU length of stay in this cohort of critically ill surgical patients," the authors write. "The lack of adverse effects, coupled with the minimal expense, supports that this combination is a reasonable therapeutic intervention in critically [ill] surgical patients."

Ann Surg. 2002;236(6):814-822

Reviewed by Gary D. Vogin, MD

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