Impact of high-dose antioxidants on outcomes in acutely injured patients
ABSTRACT The profound oxidative stress that occurs following injury results in significant depletion of many endogenous antioxidants (vitamin C, E, selenium). Increasing evidence suggests antioxidant supplementation reduces infectious complications and organ dysfunction following injury and hemorrhagic shock. The purpose of this study was to evaluate the impact of high-dose antioxidant administration on the mortality rate of acutely injured patients.
In October 2005, we implemented a 7-day high-dose antioxidant protocol for acutely injured patients admitted to our trauma center. A retrospective cohort study, evaluating all patients admitted to the trauma service between October 2005 and September 2006 following protocol implementation (AO+), was performed. The comparison cohort (AO-) was made up of those patients admitted in the year prior to protocol implementation.
A total of 4,294 patients met criteria (AO+, N = 2,272; AO-, N = 2022). Hospital (4 vs 3 days, P < .001) and ICU (3 vs 2 days, P = .001) median length of stays were significantly shorter in the AO+ group. Mortality was significantly lower in the AO+ group (6.1% vs 8.5%, P = .001), translating into a 28% relative risk reduction for mortality in patients exposed to high-dose antioxidants. After adjusting for age, gender, and probability of survival, AO exposure was associated with even lower mortality (OR 0.32, 95% CI 0.22-0.46). Patients with an expected survival <50% benefited most (OR 0.24, 95% CI 0.15-0.37).
A high-dose antioxidant protocol resulted in a 28% relative risk reduction in mortality and a significant reduction in both hospital and ICU length of stay. This protocol represents an inexpensive intervention to reduce mortality/morbidity in the trauma patient.
- SourceAvailable from: Garry Shen[Show abstract] [Hide abstract]
ABSTRACT: Hirulog-like-peptide (HLP) and low-molecular-weight heparin (LMWH) are thrombin inhibitor peptides. Our previous study demonstrated that hirulog-like-peptide could reduce vascular neointimal formation or restenosis in animals undergoing balloon catheter injury in carotid artery. However, the function of hirulog-like-peptide during ischemic stroke is largrly unknown. The present study investigated the effect of HLP on brain injury, which was induced by suture middle cerebral artery occlusion in mice. Mice were divided into 4 groups, which included a sham group and 3 treatment groups. Ischemia was induced by transient suture insertion into the middle cerebral artery for 90 minutes, and mice were either treated with saline, HLP or LMWH. Infarct volume, neurologic deficits and apoptotic factors were measured following 1 to 14 days of ischemia. We demonstrated that hirulog-like-peptide intravenous injection alleviated brain infarct volume and improved neurologic outcomes (p<0.05). HLP decreased levels of PAR-1, caspase-3, malondialdehyde (MDA) and Bax, increased the activities of catalase and Bcl-2, and improved the ratio of Bcl-2/Bax compared with the control (p<0.05). This study indicates that HLP and LMWH reduced infarct volume and improved neurobehavioral outcomes induced by tMCAO. In addition, HLP had a beneficial effect on the regulation of the thrombin receptor and key apoptosis regulators in the mouse brain. These results suggest that HLP may be a potential alternative therapy for arterial occlusion-induced cerebral ischemia.Neuroscience 07/2014; 277. DOI:10.1016/j.neuroscience.2014.07.023 · 3.33 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Patients with polytrauma can be viewed as paradigmatic of the critically-ill patient. These previously healthy patients undergo a life-threatening aggression leading to an organic response that is no different from that in other types of patients. The profile of trauma patients has changed and currently corresponds to patients who are somewhat older, with a higher body mass index and greater comorbidity. Severe injuries lead to intense metabolic stress, posing a risk of malnutrition. Therefore, early nutritional support, preferentially through the enteral route, with appropriate protein intake and glutamine supplementation, provides advantages over other routes and types of nutritional formula. To avoid overnutrition, reduced daily calorie intake can be considered in obese patients and in those with medullary lesions. However, little information on this topic is available in patients with medullary lesions.Medicina Intensiva 35:68–71. DOI:10.1016/S0210-5691(11)70014-6 · 1.24 Impact Factor