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ORIGINAL ARTICLE

Reduction of Resuscitation Fluid Volumes in Severely Burned Patients Using Ascorbic Acid Administration
A Randomized, Prospective Study
Hideharu Tanaka, MD; Takayoshi Matsuda, MD; Yasusuke Miyagantani, MD; Tetsuo Yukioka, MD; Hiroharu Matsuda, MD; Syuji Shimazaki, MD
Hypothesis: High-dose ascorbic acid (vitamin C) therapy (66 mg/kg per hour) attenuates postburn lipidperoxidation, resuscitation fluid volume requirements, and edema generation in severely burned patients. Study Design and Setting: A prospective, randomized study at a university trauma and critical care center in Japan. Subjects and Methods: Thirty-seven patients with

burns over more than 30% of their total body surface area (TBSA) hospitalized within 2 hours after injury were randomly divided intoascorbic acid and control groups. Fluid resuscitation was performed using Ringer lactate solution to maintain stable hemodynamic measurements and adequate urine output (0.5-1.0 mL/kg per hour). In the ascorbic acid group (n = 19; mean burn size, 63% ± 26% TBSA; mean burn index, 57 ± 26; inhalation injury, 15/ 19), ascorbic acid was infused during the initial 24hour study period. In the controlgroup (n = 18; mean burn size, 53% ± 17% TBSA; mean burn index, 47 ± 13; inhalation injury, 12/18), no ascorbic acid was infused. We compared hemodynamic and respiratory measurements, lipid peroxidation, and fluid balance for 96 hours after injury. Two-way analysis of variance and Tukey test were used to analyze the data.
Results: Heart rate, mean arterial pressure, central ve-

nous pressure,arterial pH, base deficit, and urine outputs were equivalent in both groups. The 24-hour total fluid infusion volumes in the control and ascorbic acid groups were 5.5 ± 3.1 and 3.0 ± 1.7 mL/kg per percentage of burn area, respectively (P .01). In the first 24 hours, the ascorbic acid group gained 9.2% ± 8.2% of pretreatment weight; controls, 17.8% ± 6.9%. Burned tissue water content was 6.1 ± 1.8 vs2.6 ± 1.7 mL/g of dry weight in the control and ascorbic acid groups, respectively (P .01). Fluid retention in the second 24 hours was also significantly reduced in the ascorbic acid group. In the control group, the ratio of PaO2 to fraction of inspired oxygen at 18, 24, 36, 48, and 72 hours after injury was less than that of the ascorbic acid group (P .01). The length of mechanical ventilation inthe control and ascorbic acid groups was 21.3 ± 15.6 and 12.1 ± 8.8 days, respectively (P .05). Serum malondialdehyde levels were lower in the ascorbic acid group at 18, 24, and 36 hours after injury (P .05).
Conclusions: Adjuvant administration of high-dose

ascorbic acid during the first 24 hours after thermal injury significantly reduces resuscitation fluid volume requirements, body weightgain, and wound edema. A reduction in the severity of respiratory dysfunction was also apparent in these patients. Arch Surg. 2000;135:326-331 In our study, we investigated whether adjuvant intravenous administration of high-dose ascorbic acid during the first 24 hours after injury also produces these beneficial effects in severely burned patients, especially the reduction of the resuscitationfluid volume requirement.
RESULTS

From the Departments of Traumatology and Critical Care Medicine, Kyorin University, Tokyo, Japan (Drs Tanaka, Miyagantani, Yukioka, H. Matsuda, and Shimazaki); and the Burn Center, Cook County Hospital, Chicago, Ill (Dr T. Matsuda).

REE RADICALS generated as a result of burn injury1 are thought to play an important role in tissue injury. Friedl and associates2demonstrated that histamine released from mast cells after burn injury increases xanthine oxidase activity, in turn producing oxygen free radicals. It has been reported previously that antioxidant therapy with continuous administration of high-dose ascorbic acid (vitamin C) reduces postburn lipid peroxidation,3 the vascular permeability increase,4 and burn and nonburn tissue edema,5 thereby...