A randomized clinical trial of ascorbic acid in open abdominal aortic aneurysm repair

Martin J Duffy; Cecilia M O'Kane; Michael Stevenson; Ian S Young; Denis W Harkin; Brian A Mullan; Daniel F McAuley

doi:10.1186/s40635-015-0050-5

A randomized clinical trial of ascorbic acid in open abdominal aortic aneurysm repair

Martin J Duffy, Cecilia M O'Kane, Michael Stevenson, Ian S Young, Denis W Harkin, Brian A Mullan, Daniel F McAuley

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Abstract

BACKGROUND: Open AAA repair is associated with ischaemia-reperfusion injury where systemic inflammation and endothelial dysfunction can lead to multiple organ injury including acute lung injury. Oxidative stress plays a role that may be inhibited by ascorbic acid.

METHODS: A double blind, allocation concealed, randomized placebo-controlled trial was performed to test the hypothesis that a single bolus dose (2g) of intra-operative parenteral ascorbic acid would attenuate biomarkers of ischaemia-reperfusion injury in patients undergoing elective open AAA repair.

RESULTS: Thirty one patients completed the study; 18 received placebo and 13 ascorbic acid. Groups were comparable demographically. Open AAA repair caused an increase in urinary Albumin:Creatinine Ratio (ACR) as well as plasma IL-6 and IL-8. There was a decrease in exhaled breath pH and oxygenation. Lipid hydroperoxides were significantly higher in the ascorbic acid group following open AAA repair. There were no other differences between the ascorbic acid or placebo groups up to 4 hours after removal of the aortic clamping.

CONCLUSIONS: Open AAA repair caused an increase in markers of systemic endothelial damage and systemic inflammation. Administration of 2g parenteral ascorbic acid did not attenuate this response and with higher levels of lipid hydroperoxides post-operatively a pro-oxidant effect could not be excluded.

TRIAL REGISTRATION: ISRCTN27369400.

Original language	English
Article number	30
Number of pages	15
Journal	Intensive Care Medicine Experimental
Volume	3
DOIs	https://doi.org/10.1186/s40635-015-0050-5
Publication status	Published - 01 Jul 2015

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10.1186/s40635-015-0050-5Licence: CC BY

A randomized clinical trial of ascorbic acid in open abdominal aortic aneurysm repair
© 2015 The Authors. This is an open access article published under a Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium, provided the author and source are cited.
Final published version, 911 KBLicence: CC BY

Cite this

@article{5ae91ca464fd4f13a226745f36a4189d,

title = "A randomized clinical trial of ascorbic acid in open abdominal aortic aneurysm repair",

abstract = "BACKGROUND: Open AAA repair is associated with ischaemia-reperfusion injury where systemic inflammation and endothelial dysfunction can lead to multiple organ injury including acute lung injury. Oxidative stress plays a role that may be inhibited by ascorbic acid.METHODS: A double blind, allocation concealed, randomized placebo-controlled trial was performed to test the hypothesis that a single bolus dose (2g) of intra-operative parenteral ascorbic acid would attenuate biomarkers of ischaemia-reperfusion injury in patients undergoing elective open AAA repair.RESULTS: Thirty one patients completed the study; 18 received placebo and 13 ascorbic acid. Groups were comparable demographically. Open AAA repair caused an increase in urinary Albumin:Creatinine Ratio (ACR) as well as plasma IL-6 and IL-8. There was a decrease in exhaled breath pH and oxygenation. Lipid hydroperoxides were significantly higher in the ascorbic acid group following open AAA repair. There were no other differences between the ascorbic acid or placebo groups up to 4 hours after removal of the aortic clamping.CONCLUSIONS: Open AAA repair caused an increase in markers of systemic endothelial damage and systemic inflammation. Administration of 2g parenteral ascorbic acid did not attenuate this response and with higher levels of lipid hydroperoxides post-operatively a pro-oxidant effect could not be excluded.TRIAL REGISTRATION: ISRCTN27369400.",

author = "Duffy, {Martin J} and O'Kane, {Cecilia M} and Michael Stevenson and Young, {Ian S} and Harkin, {Denis W} and Mullan, {Brian A} and McAuley, {Daniel F}",

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doi = "10.1186/s40635-015-0050-5",

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T1 - A randomized clinical trial of ascorbic acid in open abdominal aortic aneurysm repair

AU - Duffy, Martin J

AU - O'Kane, Cecilia M

AU - Stevenson, Michael

AU - Young, Ian S

AU - Harkin, Denis W

AU - Mullan, Brian A

AU - McAuley, Daniel F

PY - 2015/7/1

Y1 - 2015/7/1

N2 - BACKGROUND: Open AAA repair is associated with ischaemia-reperfusion injury where systemic inflammation and endothelial dysfunction can lead to multiple organ injury including acute lung injury. Oxidative stress plays a role that may be inhibited by ascorbic acid.METHODS: A double blind, allocation concealed, randomized placebo-controlled trial was performed to test the hypothesis that a single bolus dose (2g) of intra-operative parenteral ascorbic acid would attenuate biomarkers of ischaemia-reperfusion injury in patients undergoing elective open AAA repair.RESULTS: Thirty one patients completed the study; 18 received placebo and 13 ascorbic acid. Groups were comparable demographically. Open AAA repair caused an increase in urinary Albumin:Creatinine Ratio (ACR) as well as plasma IL-6 and IL-8. There was a decrease in exhaled breath pH and oxygenation. Lipid hydroperoxides were significantly higher in the ascorbic acid group following open AAA repair. There were no other differences between the ascorbic acid or placebo groups up to 4 hours after removal of the aortic clamping.CONCLUSIONS: Open AAA repair caused an increase in markers of systemic endothelial damage and systemic inflammation. Administration of 2g parenteral ascorbic acid did not attenuate this response and with higher levels of lipid hydroperoxides post-operatively a pro-oxidant effect could not be excluded.TRIAL REGISTRATION: ISRCTN27369400.

AB - BACKGROUND: Open AAA repair is associated with ischaemia-reperfusion injury where systemic inflammation and endothelial dysfunction can lead to multiple organ injury including acute lung injury. Oxidative stress plays a role that may be inhibited by ascorbic acid.METHODS: A double blind, allocation concealed, randomized placebo-controlled trial was performed to test the hypothesis that a single bolus dose (2g) of intra-operative parenteral ascorbic acid would attenuate biomarkers of ischaemia-reperfusion injury in patients undergoing elective open AAA repair.RESULTS: Thirty one patients completed the study; 18 received placebo and 13 ascorbic acid. Groups were comparable demographically. Open AAA repair caused an increase in urinary Albumin:Creatinine Ratio (ACR) as well as plasma IL-6 and IL-8. There was a decrease in exhaled breath pH and oxygenation. Lipid hydroperoxides were significantly higher in the ascorbic acid group following open AAA repair. There were no other differences between the ascorbic acid or placebo groups up to 4 hours after removal of the aortic clamping.CONCLUSIONS: Open AAA repair caused an increase in markers of systemic endothelial damage and systemic inflammation. Administration of 2g parenteral ascorbic acid did not attenuate this response and with higher levels of lipid hydroperoxides post-operatively a pro-oxidant effect could not be excluded.TRIAL REGISTRATION: ISRCTN27369400.

U2 - 10.1186/s40635-015-0050-5

DO - 10.1186/s40635-015-0050-5

M3 - Article

C2 - 26215814

SN - 2197-425X

VL - 3

JO - Intensive Care Medicine Experimental

JF - Intensive Care Medicine Experimental

M1 - 30

ER -

A randomized clinical trial of ascorbic acid in open abdominal aortic aneurysm repair

Abstract

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