Hour

FIGURE 8.12 Burn patients receiving high-dose vitamin C (VC) had higher plasma concentration of vitamin C than controls (CTRL) and lower malondialdehyde (MDA) concentration than controls.

was inhibited, and total blood protein and albumin values were maintained at a significantly higher level for 12 to 72 h after the injury in the group administered vitamin C. However, no differences existed between the two groups in the hemodynamic (blood pressure, pulse, CVP pressure, and hematocrit value) parameters; thus, both groups had similar hemodynamics. Moreover, because the vitamin C solution was adjusted to the same sodium concentration and osmolality as lactated Ringer's solution, there were no significant differences between the two groups in the Na concentration in blood and in urine, or in osmolality in the blood and urine. A notable finding in the MDA concentration and XOD activity in the blood — both indicators of the lipid peroxidation and hydroxyl radical productivity of the burn tissue — was the decrease to a normal range after administration of vitamin C, in comparison to the control group (Figure 8.12).

Members of the group administered vitamin C had a higher PO2/FiO2 ratio from 18 to 72 h after injury. The length of mechanical ventilation in the group administered vitamin C was significantly shorter. It is clear from these results that the suppression of the edema generation and the effect of inhibiting the increased vascular permeability prevented respiratory dysfunction immediately after burn injury (Figure 8.13).

The goal of fluid resuscitation during the immediate postburn period is to maintain an adequate intravascular volume with minimum amount of fluid. The clinical benefits of the reduced fluid resuscitation volume with stable hemodynamic values that we observed using vitamin C led not only to a clear reduction in edema and body weight gain, but were also associated with reduced respiratory impairment and a reduced requirement for mechanical ventilation.

The present study involved a small number of patients showing the value of high-dose vitamin C therapy as an adjunct to resuscitation in severely burned patients. Oxygen radicals play an important role in increased vascular permeability, lipid peroxidation of the cell membrane, and initiation of local and systemic inflammation after burn injury. The authors conclude that even a small improvement of respiratory and hemodynamic parameters in the initial stage of burn injury may lead to a

PaO2/FiO2 ratio

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