Role of ascorbic acid infusion in critically ill patients with transfusion-related acute lung injury

Abstract

Introduction: In critically ill patients, transfusion-related acute lung injury (TRALI) remains the leading cause of transfusion-related fatalities in critical care settings and is associated with inflammation and oxidative stress state. Recent research raised the potential efficacy of high-dose intravenous ascorbic acid (VC) in critically ill patients. Objective: The aim of this trial was to investigate the effect of high-dose intravenous VC as a targeted therapy for TRALI in terms of serum proinflammatory (interleukin [IL]-8, IL-1β, C-reactive protein), anti-inflammatory (IL-10), oxidative stress (superoxide dismutase, malondialdehyde) markers, and plasma VC levels. Secondary outcomes were oxygenation (PaO2/FiO2 ratio), vasopressor use, duration of mechanical ventilation, ICU length of stay, 7-day mortality and 28-day mortality. Methods: Eighty critically ill patients with TRALI (n = 80) were randomized to receive 2.5 g/6 h intravenous vitamin C for 96 hours (ASTRALI group) or placebo. Patients were followed up to measure the outcomes initially (T0) and at the end of treatment (T96). Results: When compared to the control group, the ASTRALI group at T96 showed significantly higher median of IL-10 (31.6 ± 25.8 vs 17.7 ± 12.0 pg/mL, P