Rationale and Effects of the Administration of Antioxidants in Critically Ill Patients

Zusammenfassung

Der erhöhte oxidative Stress bei lebensgefährlich erkrankten Patienten könnte bei der Pathogenese vielfachen Organversagens eine pathophysiologische Rolle spielen, worauf neuere klinisch therapeutische Studien mit Antioxidanzien hinzuweisen scheinen. Eine prophylaktische Verabreichung antioxidativer Vitamine oder Glutamine als Bestandteile einer unterstützenden Ernährung, oder getrennt verordnet, setzt den oxidativen Stress wirksam herab und vermindert - wie einige Studien zeigten - das Auftreten von Organversagen und bewirkt eine Besserung des Zustandes lebensgefährlich Erkrankter und damit ihrer Überlebenschancen. Patienten, bei denen die Gefahr eines Organversagens vorliegt, könnte bei rechtzeitiger Verabreichung von Antioxidanzien, einschließlich Vitaminen und Glutaminen, ein günstigerer Verlauf der Behandlung ermöglicht werden.

Abstract

The increased oxidative stress in critically ill patients could exert pathophysiological role in the pathogenesis of multiple organ failures, as suggested by recent clinical trials of antioxidant therapies. Prophylactic administration of antioxidant vitamins or glutamine, incorporated in the nutritional support or given as separate medications, efficiently attenuates the oxidative stress and in some studies, decreases the incidence of organ failures and ultimately improves the outcome of critically ill patients. Patients at risk of organ failures could benefit from the early adjunction of antioxidant treatment, including vitamins and glutamine.

Schlüsselwörter

Oxidativer Stress - Nährstoffbedarf - Vitamin A - Vitamin C - Vitamin E

Key words

Oxidative stress - nutritional support - vitamin A - ascorbic acid - vitamin E

References

• 1 Goodyear-Bruch C, Pierce J D. Oxidative stress in critically ill patients.  Am J Crit Care. 2002;  11 543-551
• 2 Cuzzocrea S, Riley D P, Caputi A P, Salvemini D. Antioxidant therapy: a new pharmacological approach in shock, inflammation, and ischemia/reperfusion injury.  Pharmacol Rev. 2001;  53 135-159
• 3 Bulger E M, Maier R V. Antioxidants in critical illness.  Arch Surg. 2001;  136 1201-1207
• 4 Brealey D, Brand M, Hargreaves I, Heales S, Land J, Smolenski R, Davies N A, Cooper C E, Singer M. Association between mitochondrial dysfunction and severity and outcome of septic shock.  Lancet. 2002;  360 (9328) 219-223
• 5 Beckman J S, Koppenol W H. Nitric oxide, superoxide, and peroxynitrite: the good, the bad, and ugly.  Am J Physiol. 1996;  271 (5 Pt 1) C1424-1437
• 6 Grisham M B, Jourd'Heuil D, Wink D A. Nitric oxide. I. Physiological chemistry of nitric oxide and its metabolites: implications in inflammation.  Am J Physiol. 1999;  276 (2 Pt 1) G315-321
• 7 Therond P, Bonnefont-Rousselot D, Davit-Spraul A, Conti M, Legrand A. Biomarkers of oxidative stress: an analytical approach.  Curr Opin Clin Nutr Metab Care. 2000;  3 373-384
• 8 Motoyama T, Okamoto K, Kukita I, Hamaguchi M, Kinoshita Y, Ogawa H. Possible role of increased oxidant stress in multiple organ failure after systemic inflammatory response syndrome.  Crit Care Med. 2003;  31 1048-1052
• 9 Bela P, Bahl R, Sane A S, Sawant P H, Shah V R, Mishra V V, Trivedi H L. Oxidative stress status: possible guideline for clinical management of critically ill patients.  Panminerva Med. 2001;  43 27-31
• 10 Alonso de Vega J M, Diaz J, Serrano E, Carbonell L F. Oxidative stress in critically ill patients with systemic inflammatory response syndrome.  Crit Care Med. 2002;  30 1782-1786
• 11 Frey B, Johnen W, Haupt R, Kern H, Rustow B, Kox W J, Schlame M. Bioactive oxidized lipids in the plasma of cardiac surgical intensive care patients.  Shock. 2002;  18 14-17
• 12 Tsai K, Hsu T, Kong C, Lin K, Lu F. Is the endogenous peroxyl radical scavenging capacity of plasma protective in systemic inflammatory disorders in humans?.  Free Radic Biol Med. 2000;  28 926-933
• 13 A.S.P.E.N. Board of Directors and the Clinical Guidelines Task Force . Guidelines for the use of parenteral and enteral nutrition in Adults and pediatric patients.  JPEN J Parenter Enteral Nutr. 2002;  26 1SA-138SA
• 14 Mathy-Hartert M, Mouithys-Mickalad A, Kohnen S, Deby-Dupont G, Lamy M, Hans P. Effects of propofol on endothelial cells subjected to a peroxynitrite donor (SIN-1).  Anaesthesia. 2000;  55 1066-1071
• 15 Tsuchiya M, Asada A, Kasahara E, Sato E F, Shindo M, Inoue M. Antioxidant protection of propofol and its recycling in erythrocyte membranes.  Am J Respir Crit Care Med. 2002;  165 54-60
• 16 Mouithys-Mickalad A, Mathy-Hartert M, Du G, Sluse F, Deby C, Lamy M, Deby-Dupont G. Oxygen consumption and electron spin resonance studies of free radical production by alveolar cells exposed to anoxia: inhibiting effects of the antibiotic ceftazidime.  Redox Rep. 2002;  7 85-94
• 17 Kang M Y, Tsuchiya M, Packer L, Manabe M. In vitro study on antioxidant potential of various drugs used in the perioperative period.  Acta Anaesthesiol Scand. 1998;  42 4-12
• 18 Wenisch C, Parschalk B, Weiss A, Zedwitz-Liebenstein K, Hahsler B, Wenisch H, Georgopoulos A, Graninger W. High-dose catecholamine treatment decreases polymorphonuclear leukocyte phagocytic capacity and reactive oxygen production.  Clin Diagn Lab Immunol. 1996;  3 423-428
• 19 Higgins T L, Murray M, Kett D H, Fulda G, Kramer K M, Gelmont D, Dedhia H V, Levy H, Teres D, Zaloga G P, Ko H, Thompson K A. Trace element homeostasis during continuous sedation with propofol containing EDTA versus other sedatives in critically ill patients.  Intensive Care Med. 2000;  26, Suppl 4 S413-421
• 20 Preiser J C, Gossum A Van, Berre J, Vincent J L, Carpentier Y. Enteral feeding with a solution enriched with antioxidant vitamins A, C, and E enhances the resistance to oxidative stress.  Crit Care Med. 2000;  28 3828-3832
• 21 Nelson J L, Michele S J De, Pacht E R, Wennberg A K. Effect of enteral feeding with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants on antioxidant status in patients with acute respiratory distress syndrome.  JPEN J Parenter Enteral Nutr. 2003;  27 98-104
• 22 Gadek J E, Michele S J De, Karlstad M D, Pacht E R, Donahoe M, Albertson T E, Hoozen C Van, Wennberg A K, Nelson J L, Noursalehi M. Effect of enteral feeding with eicosapentaenoic acid, gamma-linolenic acid, and antioxidants in patients with acute respiratory distress syndrome. Enteral Nutrition in ARDS Study Group.  Crit Care Med. 1999;  27 1409-1420
• 23 Nathens A B, Neff M J, Jurkovich G J, Klotz P, Farver K, Ruzinski J T, Radella F, Garcia I, Maier R V. Randomized, prospective trial of antioxidant supplementation in critically ill surgical patients.  Ann Surg. 2002;  236 814-822
• 24 Caparros T, Lopez J, Grau T. Early enteral nutrition in critically ill patients with a high-protein diet enriched with arginine, fiber, and antioxidants compared with a standard high-protein diet. The effect on nosocomial infections and outcome.  JPEN J Parenter Enteral Nutr. 2001;  25 299-308
• 25 Kiefer P, Vogt J, Radermacher P. From mucolytic to antioxidant and liver protection: new aspects in the intensive care unit career of N-acetylcysteine.  Crit Care Med. 2000;  28 3935-3936
• 26 Heller A R, Groth G, Heller S C, Breitkreutz R, Nebe T, Quintel M, Koch T. N-acetylcysteine reduces respiratory burst but augments neutrophil phagocytosis in intensive care unit patients.  Crit Care Med. 2001;  29 272-276
• 27 Berger M M, Shenkin A. Trace elements in trauma and burns.  Curr Opin Clin Nutr Metab Care. 1998;  1 513-517
• 28 Lassnigg A, Punz A, Barker R, Keznickl P, Manhart N, Roth E, Hiesmayr M. Influence of intravenous vitamin E supplementation in cardiac surgery on oxidative stress: a double-blinded, randomized, controlled study.  Br J Anaesth. 2003;  90 148-154
• 29 Shyu K G, Cheng J J, Kuan P. Acetylcysteine protects against acute renal damage in patients with abnormal renal function undergoing a coronary procedure.  J Am Coll Cardiol. 2002;  16, 40 1383-1388
• 30 Tepel M, Giet M van der, Schwarzfeld C, Laufer U, Liermann D, Zidek W. Prevention of radiographic-contrast-agent-induced reductions in renal function by acetylcysteine.  N Engl J Med. 2000;  20, 343 180-184
• 31 Preiser J C, Wernerman J. Glutamine, a life-saving nutrient, but why?.  Crit Care Med. 2003;  31 2555-2556
• 32 Flaring U B, Rooyackers O E, Wernerman J, Hammarqvist F. Glutamine attenuates post-traumatic glutathione depletion in human muscle.  Clin Sci (Lond). 2003;  104 275-282
• 33 Boelens P G, Houdijk A P, Thouars H N de, Teerlink T, Engeland M I van, Haarman H J, Leeuwen P A van. Plasma taurine concentrations increase after enteral glutamine supplementation in trauma patients and stressed rats.  Am J Clin Nutr. 2003;  77 250-256