Інформація призначена тільки для фахівців сфери охорони здоров'я, осіб,
які мають вищу або середню спеціальну медичну освіту.

Підтвердіть, що Ви є фахівцем у сфері охорони здоров'я.



СІМЕЙНІ ЛІКАРІ ТА ТЕРАПЕВТИ

НЕВРОЛОГИ, НЕЙРОХІРУРГИ, ЛІКАРІ ЗАГАЛЬНОЇ ПРАКТИКИ, СІМЕЙНІ ЛІКАРІ

КАРДІОЛОГИ, СІМЕЙНІ ЛІКАРІ, РЕВМАТОЛОГИ, НЕВРОЛОГИ, ЕНДОКРИНОЛОГИ

СТОМАТОЛОГИ

ІНФЕКЦІОНІСТИ, СІМЕЙНІ ЛІКАРІ, ПЕДІАТРИ, ГАСТРОЕНТЕРОЛОГИ, ГЕПАТОЛОГИ

ТРАВМАТОЛОГИ

ОНКОЛОГИ, (ОНКО-ГЕМАТОЛОГИ, ХІМІОТЕРАПЕВТИ, МАМОЛОГИ, ОНКО-ХІРУРГИ)

ЕНДОКРИНОЛОГИ, СІМЕЙНІ ЛІКАРІ, ПЕДІАТРИ, КАРДІОЛОГИ ТА ІНШІ СПЕЦІАЛІСТИ

ПЕДІАТРИ ТА СІМЕЙНІ ЛІКАРІ

АНЕСТЕЗІОЛОГИ, ХІРУРГИ

"Emergency medicine" Том 17, №1, 2021

Back to issue

Vitamin C in critical conditions: from bench to bedside (part 2)

Authors: Чуклін С.М., Чуклін С.С.
Львівська обласна клінічна лікарня, м. Львів, Україна

Categories: Medicine of emergency

Sections: Specialist manual

print version


Summary

Вітамін С (аскорбінова кислота) відіграє важливу фізіологічну роль у численних метаболічних функціях. Він також є кофактором у синтезі важливих речовин, зокрема катехоламінів і вазопресину. Зниження рівня аскорбінової кислоти відзначено при різних захворюваннях і часто супроводжує тяжкий стан хворого. Метою цієї статті є огляд сучасних уявлень щодо застосування високих доз вітаміну С при критичних станах у хірургічних хворих. Для пошуку літературних джерел використовувалася база Medline на платформі Pubmed за ключовими словами: вітамін С, сепсис, шок, травма, опіки.

Витамин С (аскорбиновая кислота) играет важную физиологическую роль в многочисленных метаболических функциях. Он также является кофактором в синтезе важных веществ, в частности катехоламинов и вазопрессина. Снижение уровня аскорбиновой кислоты отмечено при различных заболеваниях и часто сопровождает тяжелое состояние больного. Целью этой статьи является обзор современных представлений о применении высоких доз витамина С при критических состояниях у хирургических больных. Для поиска литературных источников использовалась база Medline на платформе Pubmed по ключевым словам: витамин С, сепсис, шок, травма, ожоги.

Vitamin C (ascorbic acid) plays an important physiological role in numerous metabolic functions. It is also a cofactor in the synthesis of important substances, in particular catecholamines and vasopressin. A decrease in the level of ascorbic acid has been noted in various diseases, often accompanying the severity of the patient’s state. The aim of this article is to review the current knowledge on the physiological role of vitamin C and the experimental evidences of its use in critically ill surgical patients. Medline database on the PubMed platform was used to search for the literature sources with key words: vitamin C, sepsis, shock, trauma, burns.


Keywords

вітамін С; фармакокінетика; фізіологічна роль; сепсис; шок; травма; опіки

витамин С; фармакокинетика; физиологическая роль; сепсис; шок; травма; ожоги

vitamin C; pharmacokinetics; physiological role; sepsis; shock; trauma; burns


For the full article you need to subscribe to the magazine.


Bibliography

  1. Carr A.C., Rosengrave P.C., Bayer S., et al. Hypovitaminosis C and vitamin C deficiency in critically ill patients despite recommended enteral and parenteral intakes. Crit. Care. 2017. Vol. 21. 300. 
  2. Crimi E., Liguori A., Condorelli M., et al. The beneficial effects of antioxidant supplementation in enteral feeding in critically ill patients: a prospective, randomized, double-blind, placebo-controlled trial. Anesth. Analg. 2004. Vol. 99. P. 857-863. 
  3. Collier B.R., Giladi A., Dossett L.A., et al. Impact of high dose antioxidants on outcomes in acutely injured patients. J. Parenter. Enteral. Nutr. 2008. Vol. 32. P. 384-388. 
  4. Schneider A., Markowski A., Momma M., et al. Tolerability and efficacy of a low-volume enteral supplement containing key nutrients in the critically ill. Clin. Nutr. 2011. Vol. 30. P. 599-603.
  5. Beale R.J., Sherry T., Lei K., et al. Early enteral supplementation with key pharmaconutrients improves Sequential Organ Failure Assessment score in critically ill patients with sepsis: outcome of a randomized, controlled, double-blind trial. Crit. Care Med. 2008. Vol. 36. P. 131-144. 
  6. Jackson T.S., Xu A., Vita J.A., Keaney J.F. Jr. Ascorbate prevents the interaction of superoxide and nitric oxide only at very high physiological concentrations. Circ. Res. 1998. Vol. 83. P. 916-922.
  7. de Grooth H.J., Manubulu-Choo W.P., Zandvliet A.S., et al. Vitamin C Pharmacokinetics in Critically Ill Patients: A Randomized Trial of Four IV Regimens. Chest. 2018. Vol. 153. P. 1368-1377. 
  8. Fehrman-Ekholm I., Lotsander A., Logan K., et al. Concentrations of vitamin C, vitamin B12 and folic acid in patients treated with hemodialysis and on-line hemodiafiltration or hemofiltration. Scand. J. Urol. Nephrol. 2008. Vol. 42. P.74-80. 
  9. Kamel A.Y., Dave N.J., Zhao V.M., et al. Micronutrient Alterations During Continuous Renal Replacement Therapy in Critically Ill Adults: A Retrospective Study. Nutr. Clin. Pract. 2018. Vol. 33. P. 439-446. 
  10. Honore P.M., De Bels D., Kugener L., et al. Dosing adjuvant vitamin C in critically ill patients undergoing continuous renal replacement therapy: We are not there yet! Crit. Care. 2019. Vol. 23. 5.
  11. Oudemans-van Straaten H.M., Spoelstra-de Man A., de Waard M.C. Vitamin C revisited. Crit. Care. 2014. Vol. 18. 460.
  12. Fowler A.A. 3rd, Syed A.A., Knowlson S., et al. Medical Respiratory Intensive Care Unit Nursing: Phase 1 safety trial of intravenous ascorbic acid in patients with severe sepsis. J. Transl. Med. 2014. Vol. 12. 32.
  13. Zabet M.H., Mohammadi M., Ramezani M., Khalili H. Effect of high-dose ascorbic acid on vasopressor’s requirement in septic shock. J. Res. Pharm. Pract. 2016. Vol. 5. P. 94-100.
  14. Ahn J.H., Oh D.K., Huh J.W., et al. Vitamin C alone does not improve treatment outcomes in mechanically ventilated patients with severe sepsis or septic shock: a retrospective cohort study. J. Thorac Dis. 2019. Vol. 11. P. 1562-1570. 
  15. Nathens A.B., Neff M.J., Jurkovich G.J., et al. Randomized, prospective trial of antioxidant supplementation in critically ill surgical patients. Ann. Surg. 2002. Vol. 236. P. 814-822.
  16. Berger M.M., Soguel L., Shenkin A., et al. Influence of early antioxidant supplements on clinical evolution and organ function in critically ill cardiac surgery, major trauma, and subarachnoid hemorrhage patients. Crit. Care. 2008. Vol. 12. R101.
  17. Marik P.E., Khangoora V., Rivera R., et al. Hydrocortisone, vitamin C, and thiamine for the treatment of severe sepsis and septic shock: a retrospective before-after study. Chest. 2017. Vol. 151. P. 1229-1238.
  18. Lamarche J., Nair R., Peguero A., Courville C. Vitamin C-induced oxalate nephropathy. Int. J. Nephrol. 2011. Vol. 2011. 146927. 
  19. Artenstein A.W., Higgins T.L., Opal S.M. Sepsis and scientific revolutions. Crit. Care Med. 2013. Vol. 41. P. 2770-2772. 
  20. Calvano S.E., Xiao W., Richards D.R., et al. A network-based analysis of systemic inflammation in humans. Nature. 2005. Vol. 437. P. 1032-1237. 
  21. Marik P.E. Hydrocortisone, Ascorbic Acid and Thiamine (HAT therapy) for the treatment of sepsis. Focus on ascorbic acid. Nutrients. 2018. Vol. 10. 1762.
  22. Marik P.E. Vitamin C for the treatment of sepsis: The scientific rationale. Pharmacol. Ther. 2018. Vol. 189. P. 63-70.
  23. Marik P.E., Hooper M.H. Doctor-your septic patients have scurvy! Crit. Care. 2018. Vol. 22. 23.
  24. Kashiouris M.G., L’Heureux M., Cable C.A., et al. The Emerging Role of Vitamin C as a Treatment for Sepsis. Nutrients. 2020. Vol. 12. 292.
  25. Abrams S.T., Morton B., Alhamdi Y., et al. A novel assay for neutrophil extracellular trap formation independently predicts disseminated intravascular coagulation and mortality in critically ill patients. Am. J. Respir. Crit. Care Med. 2019. Vol. 200. P. 869-880.
  26. May J.M., Harrison F.E. Role of vitamin C in the function of the vascular endothelium. Antioxid. Redox Signal. 2013. Vol. 19. P. 2068-2083.
  27. Fisher B.J., Seropian I.M., Kraskauskas D., et al. Ascorbic acid attenuates lipopolysaccharide-induced acute lung injury. Crit. Care Med. 2011. Vol. 39. P. 1454-1460.
  28. Burchfield J.S., Li Q., Wang H.Y., Wang R.F. JMJD3 as an epigenetic regulator in development and disease. Int. J. Biochem. Cell Biol. 2015. Vol. 67. P. 148-157.
  29. Oudemans-van Straaten H.M., Elbers P.W.G., Spoelstrade Man A.M.E. How to give vitamin C a cautious but fair chance in severe sepsis. Chest. 2017. Vol. 151. P. 1199-1200. 
  30. Fisher B.J., Kraskauskas D., Martin E.J., et al. Mechanisms of attenuation of abdominal sepsis induced acute lung injury by ascorbic acid. Am. J. Physiol. Lung Cell Mol. Physiol. 2012. Vol. 303. L20-32.
  31. Fowle A.A., Truwit J.D., Hite R.D., et al. Effect of Vitamin C Infusion on Organ Failure and Biomarkers of Inflammation and Vascular Injury in Patients With Sepsis and Severe Acute Respiratory Failure: The CITRIS-ALI Randomized Clinical Trial. JAMA. 2019. Vol. 322. P. 1261-1270.
  32. Moskowitz A., Andersen L.W., Huang D., et al. Ascorbic acid, corticosteroids, and thiamine in sepsis: A review of the biologic rationale and the present state of clinical evaluation. Crit. Care. 2018. Vol. 22. 283.
  33. Kim W.Y., Jo E.J., Eom J.S., et al. Combined vitamin C, hydrocortisone, and thiamine therapy for patients with severe pneumonia who were admitted to the intensive care unit: propensity score-based analysis of a before-after cohort study. J. Crit. Care. 2018. Vol. 47. P. 211-218.
  34. Rubin R. Wide Interest in a Vitamin C Drug Cocktail for Sepsis Despite Lagging Evidence (Medical New Release). JAMA. 2019. Vol. 322. P. 291-293.
  35. Khoshnam-Rad N., Khalili H. Safety of vitamin C in sepsis: a neglected topic. Curr. Opin. Crit. Care. 2019. Vol. 25. P. 329-333.
  36. Moskowitz A., Anderson L.W., Cocchi M.N., et al. Thiamine as a renal protective agent in septic shock: A secondary analysis of a randomized, double-blind, placebo-controlled trial. Ann. Am. Thorac. Soc. 2017. Vol. 14. P. 737-741.
  37. Hager D.N., Hooper M.H., Bernard G.R., et al. The Vitamin C, Thiamine and Steroids in Sepsis (VICTAS) Protocol: a prospective, multi-center, double-blind, adaptive sample size, randomized, placebo-controlled, clinical trial. Trials. 2019. Vol. 20. 197.
  38. Fujii T., Luethi N., Young P.J., et al. Effect of Vitamin C, Hydrocortisone, and Thiamine vs Hydrocortisone Alone on Time Alive and Free of Vasopressor Support Among Patients With Septic Shock: The VITAMINS Randomized Clinical Trial. JAMA. 2020. Vol. 323. P. 423-431.
  39. Tanaka H., Lund T., Wiig H., et al. High dose vitamin C counteracts the negative interstitial fluid hydrostatic pressure and early edema generation in thermally injured rats. Burns. 1999. Vol. 25. P. 569-574.
  40. Tanaka H., Matsuda T., Miyagantani Y., et al. Reduction of resuscitation fluid volumes in severely burned patients using ascorbic acid administration: a randomized, prospective study. Arch. Surg. 2000. Vol. 135. P. 326-331. 
  41. Kahn S.A., Beers R.J., Lentz C.W. Resuscitation after severe burn injury using high-dose ascorbic acid: a retrospective review. J. Burn. Care Res. 2011. Vol. 32. P. 110-117. 
  42. Adjepong M., Agbenorku P., Brown P., Oduro I. The role of antioxidant micronutrients in the rate of recovery of burn patients: a systematic review. Burns Trauma. 2016. Vol. 4. 18. 
  43. Barbosa E., Faintuch J., Machado Moreira E.A., et al. Supplementation of vitamin E, vitamin C, and zinc attenuates oxidative stress in burned children: a randomized, double-blind, placebo-controlled pilot study. J. Burn. Care Res. 2009. Vol. 30. P. 859-866.
  44. Saffle J.I. The phenomenon of „fluid creep” in acute burn resuscitation. J. Burn Care Res. 2007. Vol. 28. P. 382-395. 
  45. Saffle J.R. Fluid Creep and Over-resuscitation. Crit. Care Clin. 2016. Vol. 32. P. 587-598. 
  46. Rizzo J.A., Rowan M.P., Driscoll I.R., et al. Vitamin C in Burn Resuscitation. Crit. Care Clin. 2016. Vol. 32. P. 539-546. 
  47. Cartotto R., Greenhalgh D.G., Cancio C. Burn State of the Science: Fluid Resuscitation. J. Burn Care Res. 2017. Vol. 38. e596-604. 
  48. Nagel S.S., Radu C.A., Kremer T., et al. Safety, Pharmacodynamics, and Efficacy of High-Versus Low-Dose Ascorbic Acid in Severely Burned. Adults J. Burn Care Res. 2020. Vol.41. P. 871-877.
  49. Nakajima M., Kojiro M., Aso S., et al. Effect of high-dose vitamin C therapy on severe burn patients: a nationwide cohort study. Crit. Care. 2019. Vol. 23. 407. 
  50. Sandesc M., Florin R.A., Bedreag O.H., et al. Analysis of oxidative stress-related markers in critically ill polytrauma patients: An observational prospective single-center study. Bosn. J. Basic Med. Sci. 2018. Vol. 18. P. 191-197. 
  51. Das D., Sen C., Goswami A. Effect of Vitamin C on adrenal suppression by etomidate induction in patients undergoing cardiac surgery: A randomized controlled trial. Ann. Card. Anaesth. 2016. Vol. 19. P. 410-417. 
  52. Carr A.C., Shaw G.M., Fowler A.A., Natarajan R. Ascorbate-dependent vasopressor synthesis: a rationale for vitamin C administration in severe sepsis and septic shock? Crit. Care. 2015. Vol. 19. 418. 
  53. Moser M.A., Chun O.K. Vitamin C and Heart Health: A Review Based on Findings from Epidemiologic Studies. Int. J. Mol. Sci. 2016. Vol. 17. E1328. 
  54. McDonald C.I., Fraser J.F., Coombes J.S., Fung Y.L. Oxidative stress during extracorporeal circulation. Eur. J. Cardiothorac. Surg. 2014. Vol. 46. P. 937-943. 
  55. Wilson J.X. Mechanism of action of vitamin C in sepsis: ascorbate modulates redox signaling in endothelium. Biofactors. 2009. Vol. 35. P. 5-13. 
  56. Rodemeister S., Duquesne M., Adolph M., et al. Massive and long-lasting decrease in vitamin C plasma levels as a consequence of extracorporeal circulation. Nutrition. 2014. Vol. 30. P. 673-678. 
  57. Hu X., Yuan L., Wang H., et al. Efficacy and safety of vitamin C for atrial fibrillation after cardiac surgery: A meta-analysis with trial sequential analysis of randomized controlled trials. Int. J. Surg. 2017. Vol. 37. P. 58-64. 
  58. Valls N., Gormaz J.G., Aguayo R., et al. Amelioration of persistent left ventricular function impairment through increased plasma ascorbate levels following myocardial infarction. Redox Rep. 2016. Vol. 21. P. 75-83. 
  59. Ramos C., Brito R., González-Montero J., et al. Effects of a novel ascorbate-based protocol on infarct size and ventricle function in acute myocardial infarction patients undergoing percutaneous coronary angioplasty. Arch. Med. Sci. 2017. Vol. 13. P. 558-567. 
  60. Delafontaine P., Anwar A. Vitamin C and percutaneous coronary intervention. Jacc. Cardiovasc. Interv. 2010. Vol. 3. P. 230-232.
  61. Basili S., Tanzilli G., Mangieri E., et al. Intravenous ascorbic acid infusion improves myocardial perfusion grade during elective percutaneous coronary intervention: Relationship with oxidative stress markers. Jacc. Cardiovasc. Interv. 2010. Vol. 3. P. 221-229.
  62. Wang Z.J. The effect of intravenous vitamin C infusion on periprocedural myocardial injury for patients undergoing elective percutaneous coronary intervention. Can. J. Cardiol. 2014. Vol. 30. P. 96-101. 
  63. Khan S.A., Bhattacharjee S., Ghani M.O.A., et al. Vitamin C for Cardiac Protection during Percutaneous Coronary Intervention: A Systematic Review of Randomized Controlled Trials. Nutrients. 2020. Vol. 12. E2199.
  64. Zhang M., Jativa D.F. Vitamin C supplementation in the critically ill: a systematic review and meta-analysis. SAGE Open Med. 2018. Vol. 6. P. 1-12.
  65. Hemilä H., Chalker E. Vitamin C can shorten the length of stay in the ICU: a meta-analysis. Nutrients. 2019. Vol. 11. 708.
  66. Putzu A., Daems A.M, Lopez-Delgado J.C., et al. The effect of vitamin C on clinical outcome in critically ill patients: a systematic review with meta-analysis of randomized controlled trials. Crit. Care Med. 2019. Vol. 47. P. 774-783.
  67. Langlois P.L., Manzanares W., Adhikari N.K.J, et al. Vitamin C administration to the critically ill: a systematic review and meta-analysis. J. Parenter. Enteral. Nutr. 2019. Vol. 43. P. 335-346.
  68. Hemilä H., Chalker E. Vitamin C may reduce the duration of mechanical ventilation in critically ill patients: a meta-regression analysis. J. Intensive Care. 2020. Vol. 8. 15. 
  69. Wang Y., Lin H., Lin B., Lin J. Effects of different ascorbic acid doses on the mortality of critically ill patients: a meta-analysis. Ann. Intensive Care. 2019. Vol. 9. 58. 
  70. Wei X., Wang Z., Liao X., et al. Efficacy of vitamin C in patients with sepsis: An updated meta-analysis. Eur. J. Pharmacol. 2020. Vol. 868. 172889.

Back to issue