Role of Ascorbic Acid Infusion in Critically Ill Patients With Transfusion Related Acute Lung Injury
Status:
Completed
Trial end date:
2021-07-16
Target enrollment:
Participant gender:
Summary
TRALI was defined as "acute noncardiogenic pulmonary edema typically occurs ≤ 6 hours
following transfusion of plasma-containing blood products, such as packed red blood cells,
fresh frozen plasma, platelets, or cryoprecipitate." In critically ill patients, TRALI
remains the leading cause of transfusion-related fatalities and is accompanied by a very
significant morbidity and mortality. Survival in such patients is as low as 53% compared with
83% in acute lung injury (ALI) controls.
The incidence of TRALi is likely underreported. In densely populated developing countries,
incidence has not decreased due to lack of male-only strategy for plasma donation.
TRALI is associated with systemic inflammation characterized by low anti-inflammatory
cytokine as interleukin (IL)-10, increased pro-inflammatory cytokine as IL-8. Regulation of
inflammation should include avoidance of overproduction of inflammatory mediators. So, it can
be dampened not only by increasing IL-10 but also by decreasing IL-1β release. C-reactive
protein (CRP) is an acute phase protein which is up-regulated during infections and
inflammation. CRP was recently identified as a novel first hit in TRALI.
Till now, there is no established treatment for TRALI beyond supportive care and monitoring.
Recently, potential therapies have been reviewed, and it was concluded that the most
promising therapeutic strategies are IL-10 therapy, downregulation of CRP levels, targeting
reactive oxygen species (ROS) or blocking IL-8 receptors. So, antioxidants (such as high dose
vitamins), were recommended for future studies as potentially effective treatment.
Vitamin C hypovitaminosis is observed in 70% of critically ill despite receiving recommended
daily doses.
The aim of this study is to investigate the role of intravenous vitamin C (ascorbic acid) as
a targeted therapy for transfusion related acute lung injury (TRALI) in critically ill
patients in terms of IL-8, IL-10, CRP, SOD, malondialdehyde (MDA), vasopressor use, duration
of mechanical ventilation, ICU length of stay, 7-days mortality and 28-days mortality.