High-dose antioxidant administration is associated with a reduction in post-injury complications in critically ill trauma patients.
BACKGROUND
We recently demonstrated a high-dose antioxidant (AO) protocol was associated with reduction in mortality. The purpose of this study was to evaluate the impact of AO on organ dysfunction and infectious complications following injury.


METHODS
High-dose AO protocol: ascorbic acid 1000 mg q 8 h, alpha-tocopherol 1000 IU q 8 h, and selenium 200 mcg qd for 7-day course. Retrospective cohort study evaluating all patients admitted after protocol implementation (AO+), October 1, 2005 to September 30, 2006. Comparison cohort (AO-): all patients admitted in the year prior to implementation, October 1, 2004 to September 30, 2005.


RESULTS
2272 patients included in the AO+ group, 2022 patients in the AO- group. Demographics and injury severity were similar. Abdominal compartment syndrome (ACS) (2.9% vs. 0.7%, <0.001), surgical site infections (2.7% vs. 1.3%, p=0.002), pulmonary failure (27.6% vs. 17.4%, p<0.001), and ventilator-dependent respiratory failure (10.8% vs. 7.1%, p<0.001) were significantly less in the AO+ group. Multivariate regression showed 53% odds reduction in abdominal wall complications and 38% odds reduction in respiratory failure in the AO+ group.


CONCLUSIONS
Implementation of a high-dose AO protocol was associated with a reduction in respiratory failure and ventilator-dependence. In addition, AO were associated with a marked decrease in abdominal wall complications, including ACS and surgical site infections.
Giladi
Aviram M
AM
Department of Surgery, University of Michigan, Ann Arbor, MI, United States.
Dossett
Lesly A
LA
Fleming
Sloan B
SB
Abumrad
Naji N
NN
Cotton
Bryan A
BA
D000328:Adult; D000704:Analysis of Variance; D000975:Antioxidants / Q000008:administration & dosage*; D001205:Ascorbic Acid / Q000008:administration & dosage*; D016638:Critical Illness / Q000401:mortality*; D019587:Dietary Supplements; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012643:Selenium / Q000008:administration & dosage*; D016019:Survival Analysis; D016896:Treatment Outcome; D014810:Vitamin E / Q000008:administration & dosage*; D014947:Wounds and Injuries / Q000150:complications / Q000188:drug therapy* / Q000401:mortality
D000975:Antioxidants; D014810:Vitamin E; D012643:Selenium; D001205:Ascorbic Acid