Vitamin C to Improve Organ Dysfunction in Cardiac Surgery Patients—Review and Pragmatic Approach

Abstract

The pleiotropic biochemical and antioxidant functions of vitamin C have sparked recent interest in its application in intensive care. Vitamin C protects important organ systems (cardiovascular, neurologic and renal systems) during inflammation and oxidative stress. It also influences coagulation and inflammation; its application might prevent organ damage. The current evidence of vitamin C’s effect on pathophysiological reactions during various acute stress events (such as sepsis, shock, trauma, burn and ischemia-reperfusion injury) questions whether the application of vitamin C might be especially beneficial for cardiac surgery patients who are routinely exposed to ischemia/reperfusion and subsequent inflammation, systematically affecting different organ systems. This review covers current knowledge about the role of vitamin C in cardiac surgery patients with focus on its influence on organ dysfunctions. The relationships between vitamin C and clinical health outcomes are reviewed with special emphasis on its application in cardiac surgery. Additionally, this review pragmatically discusses evidence on the administration of vitamin C in every day clinical practice, tackling the issues of safety, monitoring, dosage, and appropriate application strategy.

Effects of Vitamin C on Organ Function in Cardiac Surgery Patients: A Systematic Review and Meta-Analysis

“…In the past, several strategies have been developed to modulate and reduce the inflammatory responses, such as less invasive surgical techniques, leukocyte filters during cardiopulmonary bypass, and the use of immune-modulating drugs [3]. Despite these improvements, acute and persistent organ dysfunctions still occur frequently after cardiac surgery and consequently affect the patient’s outcome and quality of life [4,5]. …”

“…Vitamin C is a strong antioxidant, thereby countering the influence of free radicals and protecting the cells and organs from damage to macromolecules, such as cell membranes and DNA. Other crucial functions are vasopressor synthesis, restoration of vasopressor sensitivity, synthesis of collagen and carnitine, preservation of endothelial barriers and modulation of immune function [4,6,7,8,9,10]. …”

Nutrition and microRNAs: Novel Insights to Fight Sarcopenia

“…Vitamin C is a water-soluble antioxidant introduced in humans by dietary intake. Elevated levels of vitamin C are associated with a lower risk of hypertension, heart disease, and stroke [ 128 ]. This vitamin also promotes the regeneration of fat-soluble vitamin E in the cell membrane [ 129 ].…”

Power for the Sickest: Vitamin C for Vasoplegia after Cardiac Surgery

“…4 Multiple organ dysfunction syndrome also can occur and patients may exhibit unique benefits to parenteral AA dosing, including reduction in vasopressor needs. 5 At our institution, a quaternary care academic hospital, total norepinephrine (NE) equivalent doses were determined for a set of 12 random patients to complete power calculations to determine the sample size needed to evaluate AA's impact on NE dosing (Table 1). For our patient sample, the mean total NE equivalent dose was 51.6 § 59.0 mg/kg (mean § standard deviation).…”