Modulation of the Redox Expression and Inflammation Response in the Critically Ill Polytrauma Patient with Thoracic Injury. Statistical Correlations between Antioxidant Therapy.
BACKGROUND
One of the major causes of mortality in the world is represented by multiple traumas. Thoracic trauma is commonly associated with polytraumas. A series of physiopathological complications follow polytraumas, leading to a significant decrease in the survival rate. As a result of injuries, significant quantities of free radicals (FR) are produced, responsible for oxidative stress (OS). To minimize the effects of OS, we recommend the administration of antioxidant substances. In this study we want to highlight statistically significant correlations between antioxidant therapy and a series of clinical variables.


METHODS
This retrospective study included 132 polytrauma patients admitted to the ICU-CA between January 2013 and December 2014. The selection criteria were: injury severity score (ISS) ≥ 16, ≥ 18 years, presence of thoracic trauma (abbreviated injury scale, AIS ≥ 3). Eligible patients (n = 82) were divided into two groups: Group 1 (n = 32, antioxidant free, patients from 2013) and Group 2 (n = 50 antioxidant therapy, patients from 2014). Antioxidant therapy consisted in the administration of vitamin C (i.v.), vitamin B1 (i.v.), and N-acetylcysteine (i.v.). Clinical and biological tests were repeated until discharge from ICU-CA or death.


RESULTS
Between Group 1 and Group 2 statistically significant differences were highlighted regarding the ISS score (p = 0.0030). 66% of patients from Group 2 were admitted at more than 24 hours after the trauma, in contrast to the patients from Group 1, where 62.5% were directly admitted to the ICU (p = 0.0114). Compared with the patients from Group 1, patients who received antioxidant therapy show improved parameters: leukocytes (p < 0.0001), platelets (p = 0.0489), urea (p = 0.0199), total bilirubin (p = 0.0111), alanine transaminase (p = 0.0010), lactat dehydrogenase (p < 0.0001). Between the two groups there were no statistically significant differences regarding the length of stay in the ICU-CA (p = 0.4697) and mortality (p = 0.1865).


CONCLUSIONS
Following the study, we can affirm that due to the administration of antioxidant substances, posttraumatic complications are greatly reduced. Moreover, the administration of high dose of antioxidants remarkably improves the clinical status of the critical patient.
Ovidiu H
OH
Bedreag
Alexandru F
AF
Rogobete
Dorel
D
Sandesc
Carmen A
CA
Cradigati
Mirela
M
Sarandan
Sonia E
SE
Popovici
Raluca
R
Dumache
Florin G
FG
Horhat
Corina
C
Vernic
Laurentiu V
LV
Sima
Loredana
L
Luca
Marius
M
Papurica
D015998:Abbreviated Injury Scale; D000111:Acetylcysteine / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D000975:Antioxidants / Q000008:administration & dosage*; D001205:Ascorbic Acid / Q000008:administration & dosage; D016638:Critical Illness; D005260:Female; D006801:Humans; D015994:Incidence; D007249:Inflammation / Q000378:metabolism; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000453:epidemiology; D009104:Multiple Trauma / Q000150:complications / Q000378:metabolism*; D010084:Oxidation-Reduction; D018384:Oxidative Stress; D012121:Respiration, Artificial; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology; D013831:Thiamine / Q000008:administration & dosage; D013898:Thoracic Injuries / Q000150:complications / Q000378:metabolism*
D000975:Antioxidants; D001205:Ascorbic Acid; D000111:Acetylcysteine; D013831:Thiamine