High-Dose Ascorbic Acid for Burn Shock Resuscitation May Not Improve Outcomes

Abstract

High dose ascorbic acid (HDAA) has been touted to ameliorate inflammation and reduce fluid requirements during burn shock resuscitation (BSR). Whether this leads to improved outcomes is not known. The authors' aim for this study was to compare ventilator days, ventilator-associated pneumonia, and mortality between patients who did and did not receive HDAA during BSR.The authors performed a retrospective case control study from 2012 to 2015. They identified 38 patients (HDAA) who received HDAA during BSR. Using age and %TBSA, the authors identified and matched 42 control patients (CTL) who did not receive HDAA for BSR during that same time period. The authors collected data for age, %TBSA, hospital days (LOS), ventilator days (VENT), inhalation injury (INH), ventilator-associated pneumonia (VAP), and mortality (MORT).There were no differences in age and %TBSA or %TBSA of third-degree burn injury between groups. There was no significant difference in the incidence of INH (HDAA-52% vs CTL-36%, P = .17) and the groups had similar LOS and VENT. Additionally, there was no significant difference in VAP incidence (HDAA-29% vs CTL-14%, P = .13) or mortality (HDAA-26% vs CTL-23%, P = .8). HDAA patients had a numerically higher incidence of acute renal failure requiring dialysis (23 vs 7%, P = .06) which was confirmed in a multivariate analysis (odds ratio 5.4; 95% confidence interval 1.1-26). HDAA, while potentially reducing inflammation and fluid requirements during BSR, may not improve any meaningful outcomes such as ventilator requirements, ventilator-associated pneumonia, and mortality.

Effects of different ascorbic acid doses on the mortality of critically ill patients: a meta-analysis

“…Our analysis among trials [16, 17, 19] suggested that AA intervention did not reduce the fluid requirement during the first 24 h of admission (SMD = − 0.52; 95% CI (− 1.63–0.58); p = 0.351; I 2 = 88.2%, Fig. 5).…”

“…The characteristics of each trial are shown in Table 1. The studies recruited patients with severe sepsis or septic shock [15, 16, 20, 24], burn shock [17–19], critical injury [21, 22], post-operation [14, 16, 36], trauma [36] and those in need of contrast-enhanced CT in the ICU [23]. The sample sizes ranged from 20 to 595.…”

“…Other studies [48] have shown that 10 g/d AA is associated with supranormal plasma concentrations. Considerable adverse effects have not been reported at high AA doses (66 mg/kg/h) [17–19]. In this study, we defined a dose lower than 3 g/d (not inclusive of 3 g/d) as low, higher than 10 g/d (inclusive of 10 g/d) as high, and 3–10 g/d as medium.…”

“…For high doses of AA, no loss of mortality was observed. Among the three trials [15–19, 21] participants suffering from burn injuries were recruited and the majority of deaths did not occur during resuscitation, but from subsequent infections [54]. In addition, patients in group B of the study by Razmkon and coworkers [21] received 10 g on the first day of admission which was repeated on day 4, followed by 4 g/d for the remaining 3 days.…”

“…Despite promising preliminary results, the benefits of AA remain controversial. Marik and coworkers [20] stated that AA as part of a “cocktail” therapy can reduce mortality in critically ill patients (8.5% vs. 40.4%, p < 0.01), while Lin et al [19] reported no significant effects of AA infusion (26% vs. 23%, p = 0.8). Notably, the dose of AA varied between these studies, which may account for the discrepancies.…”