The beneficial effects of antioxidant supplementation in enteral feeding in critically ill patients: a prospective, randomized, double-blind, placebo-controlled trial.
We investigated whether intervention with antioxidant vitamins C and E in enteral feeding influenced oxidative stress and clinical outcome in critically ill patients. Two-hundred-sixteen patients expected to require at least 10 days of enteral feeding completed the study. One-hundred-five patients received enteral feeding supplemented with antioxidants, and 111 control patients received an isocaloric formula. Plasma lipoperoxidation (by thiobarbituric acid reactive substances [TBARS] and prostaglandin F(2alpha) isoprostane levels), low-density lipoprotein (LDL) oxidizability, and LDL tocopherol content were determined at baseline and at the end of the 10-day period. The clinical 28-day outcome was also assessed. Plasma TBARS and isoprostanes were 5.33 +/- 1.26 nM/mL and 312 +/- 68 pg/mL, respectively, before treatment and 2.42 +/- 0.61 nM/mL and 198 +/- 42 pg/mL after intervention (P < 0.01 for both comparisons). Antioxidants improved LDL resistance to oxidative stress by approximately 30% (the lag time before treatment was 87 +/- 23 min and was 118 +/- 20 min after treatment; P < 0.04). There was a significantly reduced 28-day mortality after antioxidant intervention (45.7% in the antioxidant group and 67.5% in the regular-feeding group; P < 0.05). Isoprostanes may provide a sensitive biochemical marker for dose selection in studies involving antioxidants.
Crimi
Ettore
E
*Department of Anesthesiology and Intensive Care, University of Eastern Piedmont, Novara, Italy; †Coronary Care Unit, Pellegrini Hospital, Naples, Italy; ‡Department of Medicine, University of Naples, Naples, Italy; §Division of Clinical Pathology, II University of Naples, Naples, Italy; and ||Department of Anesthesiology and Intensive Care, University of Catania, Catania, Italy.
Liguori
Antonio
A
Condorelli
Mario
M
Cioffi
Michele
M
Astuto
Marinella
M
Bontempo
Paola
P
Pignalosa
Orlando
O
Vietri
Maria Teresa
MT
Molinari
Anna Maria
AM
Sica
Vincenzo
V
Corte
Francesco Della
FD
Napoli
Claudio
C
D000328:Adult; D000368:Aged; D000975:Antioxidants / Q000008:administration & dosage*; D016638:Critical Illness; D004311:Double-Blind Method; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D028421:Isoprostanes / Q000097:blood; D015227:Lipid Peroxidation; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress; D011446:Prospective Studies
D000975:Antioxidants; D028421:Isoprostanes