Perioperative ascorbic acid supplementation does not reduce the incidence of postoperative atrial fibrillation in on-pump coronary artery bypass graft patients

Antonic, Miha; Lipovec, Robert; Gregorcič, Franc; Jurič, Peter; Košir, Gorazd

doi:10.1016/j.jjcc.2016.01.010

Cited by 24 publications

(20 citation statements)

References 29 publications

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“…The remaining 53 articles were assessed for eligibility. Notable exclusions were due to pre- or perioperative administration for scheduled cardiac (n = 14), 40 – 53 gastrointestinal (n = 1), 54 vascular (n = 1), 55 or gynecologic (n = 1) 56 surgery, administration as part of combination therapy with other agents (n = 27), 27 – 31 , 57 – 78 or case reports (n = 3). 79 – 81 Many of the above were also excluded due to enteral administration.…”

Section: Resultsmentioning

confidence: 99%

Vitamin C supplementation in the critically ill: A systematic review and meta-analysis

Zhang

Jativa

2018

SAGE Open Medicine

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Background:Low plasma levels of vitamin C are associated with adverse outcomes, including increased mortality, in critically ill patients. Several trials have suggested that the administration of intravenous vitamin C in this setting may have beneficial effects, such as reducing the incidence of organ failure and improving survival. However, these studies have generally involved combination therapies consisting of vitamin C along with other antioxidants, confounding the effects of vitamin C alone. The primary objective of this meta-analysis is to investigate the effects of isolated intravenous supplementation of vitamin C in adults with critical illness.Methods:A database search was conducted for studies on the use of intravenous vitamin C in adult patients with critical illness. The primary outcome assessed was mortality at the longest follow-up time available. Secondary outcomes were the duration of mechanical ventilation, duration of vasopressor support, fluid requirements, and urine output in the first 24 h of intensive care unit admission.Results:Five studies (four randomized controlled trials and one retrospective review) enrolling a total of 142 patients were included in this meta-analysis. Compared with controls, the administration of intravenous vitamin C was associated with a decreased need for vasopressor support (standardized mean difference −0.71; 95% confidence interval (−1.16 to −0.26); p = 0.002) and decreased duration of mechanical ventilation (standardized mean difference −0.5; 95% confidence interval (−0.93 to −0.06); p = 0.03), but no difference was found in mortality (odds ratio 0.76; 95% confidence interval (0.27 to 2.16); p = 0.6). Trends were also noted toward decreased fluid requirements and increased urine output. No adverse effects were reported.Conclusion:The administration of intravenous vitamin C may lead to vasopressor sparing effects and a reduced need for mechanical ventilation in the critically ill, without affecting overall mortality. However, these results should be interpreted in light of the limitations of the primary literature and should serve as a preview of upcoming trials in this area.

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Section: Resultsmentioning

confidence: 99%

Vitamin C supplementation in the critically ill: A systematic review and meta-analysis

Zhang

Jativa

2018

SAGE Open Medicine

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“…The full text of the remaining 26 trials was reviewed for detailed evaluation, and 17 RCTs were included in qualitative synthesis. Finally, 13 trials were involved for quantitative analysis . The flow chart of study selection is shown in Figure .…”

Section: Resultsmentioning

confidence: 99%

“…Though the definition of POAF varied among the trials, the main characteristic is an episode of AF lasting beyond a certain period or requiring urgent intervention. Among the thirteen included studies, all reported the POAF events; eleven of them reported it as the primary outcome; nine of them reported HLOS; eight reported ICU length of stay; and eight reported the adverse events . The risk of bias of the included studies was high in three studies, unclear in five studies, and low in five studies (Figure ).…”

Section: Resultsmentioning

confidence: 99%

Sole and combined vitamin C supplementation can prevent postoperative atrial fibrillation after cardiac surgery: A systematic review and meta‐analysis of randomized controlled trials

Shi

Chen

et al. 2018

Clinical Cardiology

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We undertook a systematic review and meta-analysis to evaluate the effect of vitamin C supplementation (vitamin C solely or as adjunct to other therapy) on prevention of postoperative atrial fibrillation (POAF) in patients after cardiac surgery. PubMed, Embase, Web of Science, and Cochrane Library were systematically searched to identify randomized controlled trials assessing the effect of vitamin C supplementation in adult patients undergoing cardiac surgery, and the meta-analysis was performed with a random-effects model. Thirteen trials involving 1956 patients were included. Pooling estimate showed a significantly reduced incidence of POAF (relative risk [RR]: 0.68, 95% confidence interval [CI]: 0.54 to 0.87, P = 0.002) both in vitamin C alone (RR: 0.75, 95% CI: 0.63 to 0.90, P = 0.002) and as an adjunct to other therapy (RR: 0.32, 95% CI: 0.20 to 0.53, P < 0.001). The results remain stable and robust in subgroup and sensitivity analyses, and trial sequential analysis also confirmed that the evidence was sufficient and conclusive. Additionally, vitamin C could significantly decrease intensive care unit length of stay (weighted mean difference: -0.24 days, 95% CI: -0.45 to -0.03, P = 0.023), hospital length of stay (weighted mean difference: -0.95 days, 95% CI: -1.64 to -0.26, P = 0.007), and risk of adverse events (RR: 0.45, 95% CI: 0.21 to 0.96, P = 0.039). Use of vitamin C alone and as adjunct to other therapy can prevent POAF in patients undergoing cardiac surgery and should be recommended for patients receiving cardiac surgery for prevention of POAF.

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“…Existing evidence indicating whether perioperative use of vitamin C can reduce the incidence of postoperative AF is still inconsistent. [19][20][21] This difference in results may be due to different regimens of vitamin C.…”

Section: Discussionmentioning

confidence: 99%

<p>Effect of Intravenous Injection of Vitamin C on Postoperative Pulmonary Complications in Patients Undergoing Cardiac Surgery: A Double-Blind, Randomized Trial</p>

Wang¹,

Wang²,

Zhang³

et al. 2020

DDDT

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In this study, the effect of intravenous vitamin C during surgery on the incidence of postoperative pulmonary complications (PPCs) in patients undergoing cardiopulmonary bypass and cardiac surgery was observed, and its protective effect on the lungs was evaluated to provide a reference for clinical medication. Patients and Methods: Patients undergoing cardiac surgery under cardiopulmonary bypass (CPB) were selected. The patients were divided into group A and group C by random sequence. Patients in group A received intravenous vitamin C 1 g 10 minutes after induction of anesthesia, 10 minutes before cardiac reanimation and at the moment of sternal closure. Patients in group C were intravenously injected with the same volume of saline at the same time. The primary outcome was the postoperative pulmonary complication severity score. Other outcomes were the incidence of PPCs, awakening time, extubation time, length of ICU stay, length of hospital stay, adverse events, oxygenation index (PaO 2 /FiO 2), alveolar arterial oxygen partial pressure difference (A-aDO 2), dynamic lung compliance (Cd) and static lung compliance (Cs). Results: Seventy patients completed the study. Compared to group C, the postoperative pulmonary complication score [2(2-3) vs 2(1-2); P=0.009] and the incidence of postoperative pulmonary complications (32.43% vs 12.12%; P =0.043) were lower in group A. There were no significant differences in awakening time, extubation time, length of ICU stay, length of hospital stay, adverse events, PaO 2 /FiO 2 , A-aDO 2 , Cs, and Cd between the two groups (P>0.05). Conclusion: In summary, this small randomized trial including low-risk cardiac surgery patients shows that intravenous vitamin C may safely be administered and may be helpful to prevent PPCs after cardiac surgery.

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Perioperative ascorbic acid supplementation does not reduce the incidence of postoperative atrial fibrillation in on-pump coronary artery bypass graft patients

Abstract: The results of this study do not support the effectiveness of ascorbic acid supplementation in reducing the incidence of postoperative atrial fibrillation in elective on-pump CABG patients.

Cited by 24 publications

References 29 publications

Vitamin C supplementation in the critically ill: A systematic review and meta-analysis

Vitamin C supplementation in the critically ill: A systematic review and meta-analysis

Sole and combined vitamin C supplementation can prevent postoperative atrial fibrillation after cardiac surgery: A systematic review and meta‐analysis of randomized controlled trials

<p>Effect of Intravenous Injection of Vitamin C on Postoperative Pulmonary Complications in Patients Undergoing Cardiac Surgery: A Double-Blind, Randomized Trial</p>

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