Vitamins E and C May Reduce Complications After Surgery in Trauma Patients

BACKGROUND: Many patients who initially survive traumatic injuries die within weeks from infection or organ dysfunction. There is evidence that the immune response to tissue injuries generates large numbers of free radicals. These free radicals can damage tissues, leading to acute respiratory stress, respiratory failure, and multiple organ failure.
Antioxidants may reduce the risk of complications and death in trauma patients if administered before secondary injuries or infection.

RESEARCH: Researchers treated 595 patients, mostly young and middle-aged men who had suffered trauma. All underwent surgery and standard recuperative care in an intensive care unit (ICU), but approximately half of them also received vitamin E (1,000 IU) and vitamin C (1,000 mg) every eight hours while in the ICU up to 28 days. The vitamin E was administered through nasal or oral tubes, whereas the vitamin C was given intravenously.
The risk of respiratory distress such as pneumonia was the principal basis for determining the benefit of the vitamins. Secondary benefits were based on the development of multiple organ failure, how long patients needed mechanically assisted ventilation, their length of stay in the intensive care unit (ICU), and death up to 28 days following surgery.

RESULTS: The risk of developing acute respiratory distress syndrome and/or pneumonia was reduced by 19 percent (not statistically significant) in patients receiving vitamins E and C, compared with those who received standard treatment alone. In addition, patients receiving vitamins E and C had a statistically significant 57 percent lower risk of developing multiple organ failure. Patients receiving the vitamins required fewer days of mechanical ventilation and spent less time in the ICU. There were no reports of adverse effects from administration of the antioxidants.

IMPLICATIONS: The researchers concluded by noting that these critically ill surgical patients benefited from the "routine early, prophylactic administration of alpha-tocopherol [vitamin E] and ascorbate [vitamin C]...The lack of adverse effects, coupled with the minimal expense, supports that this combination is a reasonable therapeutic intervention in critically surgical patients."

Nathens AB, Neff MJ, Jurkovich GJ, et al, "Randomized, prospective trial of antioxidant supplementation in critically ill surgical patients," Annals of Surgery, 2002;236:814-822.

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