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Cited by 52Respiratory Support and MechanismsClinical Nutrition and GastroenterologyNosocomial Infections in ICU

Mechanical Ventilation Antioxidant Trial

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Howe, Kimberly P., Clochesy, John M., Goldstein, Lawrence S., Owen, Hugh·2015·American Journal of Critical Care
DOI 10.4037/ajcc2015335
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Abstract

Background: Many patients each year require prolonged mechanical ventilation. Inflammatory processes may prevent successful weaning, and evidence indicates that mechanical ventilation induces oxidative stress in the diaphragm, resulting in atrophy and contractile dysfunction of diaphragmatic myofibers. Antioxidant supplementation might mitigate the harmful effects of the oxidative stress induced by mechanical ventilation. Objective: To test the clinical effectiveness of antioxidant supplementation in reducing the duration of mechanical ventilation. Methods: A randomized, prospective, placebo-controlled double-blind design was used to test whether enterally administered antioxidant supplementation would decrease the duration of mechanical ventilation, all-cause mortality, and length of stay in the intensive care unit and hospital. Patients received vitamin C 1000 mg plus vitamin E 1000 IU, vitamin C 1000 mg plus vitamin E 1000 IU plus N-acetylcysteine 400 mg, or placebo solution as a bolus injection via their enteral feeding tube every 8 hours. Results: Clinical and statistically significant differences in duration of mechanical ventilation were seen among the 3 groups (Mantel-Cox log rank statistic = 5.69, df = 1, P = .017). The 3 groups did not differ significantly in all-cause mortality during hospitalization or in the length of stay in the intensive care unit or hospital. Conclusions: Enteral administration of antioxidants is a simple, safe, inexpensive, and effective intervention that decreases the duration of mechanical ventilation in critically ill adults.

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  • Circulating levels of copper, selenium, zinc, and vitamins E and C are decreased below reference ranges in severe critical care conditions in association with intense inflammation.

    “The antioxidant micronutrients, and in particular copper, selenium, zinc, and vitamins E and C belong to the primary antioxidant defenses: their circulating levels are decreased below reference ranges in these conditions (282,283,284,285) in association with intense inflammation.”

    From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [283]

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Authors
Howe, K. P., Clochesy, J. M., Goldstein, L. S., & Owen, H.
Affiliations
University of South Florida (US)
Corresponding author
Owen, Hugh
ORCID
Clochesy, John M.
Venue
American Journal of Critical Care
Publisher
AACN Publishing
Published
2015-09-01
Volume
24
Issue
5
Pages
440-445
ISSN
  • 1062-3264 (ISSN-L)
  • 1937-710X
DOI
10.4037/ajcc2015335
OpenAlex
W2151953286
Cited by
52
References
88
Citations by year
2025: 1 · 2024: 1 · 2023: 5 · 2022: 4 · 2021: 11 · 2020: 8 · 2019: 9 · 2018: 8 · 2017: 2 · 2016: 3
FWCI
3.43
Type
journal article
Language
en
Open access
Locations
  • American Journal of Critical Care (publishedVersion)
  • PubMed (publishedVersion)
  • Digital Commons - University of South Florida (University of South Florida) (submittedVersion)
  • OhioLink ETD Center (Ohio Library and Information Network) (submittedVersion)
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
Keywords
mechanical ventilation, antioxidant supplementation, oxidative stress, diaphragm, weaning from mechanical ventilation, vitamin C, vitamin E, N-acetylcysteine, enteral administration, critically ill adults, all-cause mortality, ICU length of stay
MeSH terms
Adult, Aged, Aged, 80 and over, Antioxidants, Ascorbic Acid, Critical Care, Cystine, Double-Blind Method, Female, Humans, Inflammation, Length of Stay, Male, Middle Aged, Prospective Studies, Respiration, Artificial, Time Factors, Vitamin E, Vitamins, Critical Illness, Treatment Outcome, Oxidative Stress

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