scholarly journals Feasibility of the REDOXS study – reducing deaths due to oxidative stress: a randomized pilot trial of glutamine and antioxidant supplementation in critically ill patients

Critical Care ◽  
2007 ◽  
Vol 11 (Suppl 2) ◽  
pp. P154
Author(s):  
D Heyland ◽  
R Dhaliwal ◽  
J Muscedere ◽  
J Drover
Keyword(s):  
Oxidative Stress ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Pilot Trial ◽  
Antioxidant Supplementation

scholarly journals REducing Deaths due to OXidative Stress (The REDOXS© Study): rationale and study design for a randomized trial of glutamine and antioxidant supplementation in critically-ill patients

2006 ◽  
Vol 65 (3) ◽  
pp. 250-263 ◽  
Author(s):  
Daren K. Heyland ◽  
Rupinder Dhaliwal ◽  
Andrew G. Day ◽  
John Muscedere ◽  
John Drover ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Randomized Trial ◽  
Critically Ill ◽  
Organ Dysfunction ◽  
Critically Ill Patients ◽  
Tertiary Care ◽  
Antioxidant Therapy ◽  
Favourable Effect ◽  
High Dose ◽  
Antioxidant Supplementation

Critically-ill patients experience an extent of hyperinflammation, cellular immune dysfunction, oxidative stress and mitochondrial dysfunction. Supplementation with key nutrients, such as glutamine and antioxidants, is most likely to have a favourable effect on these physiological derangements, leading to an improvement in clinical outcomes. The results of two meta-analyses suggest that glutamine and antioxidants may be associated with improved survival. The purpose of the present paper is to report the background rationale and study protocol for the evaluation of the effect of high-dose glutamine and antioxidant supplementation on mortality in a large-scale randomized trial in 1200 mechanically-ventilated, critically-ill patients. Patients admitted to an intensive care unit (ICU) with clinical evidence of severe organ dysfunction will be randomized to one of four treatments in a 2×2 factorial design: (1) glutamine; (2) antioxidant therapy; (3) glutamine and antioxidant therapy; (4) placebo. The primary outcome for this study is 28 d mortality. The secondary outcomes are duration of stay in ICU, adjudicated diagnosis of infection, multiple organ dysfunction, duration of mechanical ventilation, length of stay in hospital and health-related quality of life at 3 and 6 months. A novel design feature is the combined use of parenteral and enteral study nutrients dissociated from the nutrition support. The therapeutic strategies tested in the randomized trial may lead to less morbidity and improved survival in critically-ill patients. The trial will be conducted in approximately twenty tertiary-care ICU in Canada and the first results are expected in 2009.

scholarly journals Real‐Time Energy Exposure Is Associated With Increased Oxidative Stress Among Feeding‐Tolerant Critically Ill Patients: Results From the FEDOX Trial

2020 ◽  
Vol 44 (8) ◽  
pp. 1484-1491 ◽  
Author(s):  
Liam McKeever ◽  
Sarah J. Peterson ◽  
Sofia Cienfuegos ◽  
Jaime Rizzie ◽  
Omar Lateef ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Real Time ◽  
Critically Ill ◽  
Critically Ill Patients

Oxidative Stress in Critically Ill Patients

2002 ◽  
Vol 11 (6) ◽  
pp. 543-551 ◽  
Author(s):  
Caryl Goodyear-Bruch ◽  
Janet D. Pierce
Keyword(s):  
Oxidative Stress ◽  
Reactive Oxygen Species ◽  
Superoxide Dismutase ◽  
Free Radicals ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Oxygen Free Radicals ◽  
Oxygen Species ◽  
Defense System ◽  
Oxygen Derived Free Radicals

Oxygen-derived free radicals play an important role in the development of disease in critically ill patients. Normally, oxygen free radicals are neutralized by antioxidants such as vitamin E or enzymes such as superoxide dismutase. However, in patients who require intensive care, oxygen free radicals become a problem when either a decrease in the removal or an overproduction of the radicals occurs. This oxidative stress and the damage due to it have been implicated in many diseases in critically ill patients. Many drugs and treatments now being investigated are directed toward preventing the damage from oxidative stress. The formation of reactive oxygen species, the damage caused by them, and the body’s defense system against them are reviewed. New interventions are described that may be used in critically ill patients to prevent or treat oxidative damage.

scholarly journals A Prospective Pilot Trial to Assess the Efficacy of Argatroban (Argatra®) in Critically Ill Patients with Heparin Resistance †

2020 ◽  
Vol 9 (4) ◽  
pp. 963 ◽  
Author(s):  
Mirjam Bachler ◽  
Tobias Hell ◽  
Johannes Bösch ◽  
Benedikt Treml ◽  
Bettina Schenk ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Treatment Success ◽  
Pilot Trial ◽  
Treatment Phase ◽  
Thromboembolic Complications ◽  
Treatment Groups ◽  
Heparin Resistance ◽  
Significant Difference ◽  
Prophylactic Anticoagulation

The current study aims to evaluate whether prophylactic anticoagulation using argatroban or an increased dose of unfractionated heparin (UFH) is effective in achieving the targeted activated partial thromboplastin time (aPTT) of more than 45 s in critically ill heparin-resistant (HR) patients. Patients were randomized either to continue receiving an increased dose of UFH, or to be treated with argatroban. The endpoints were defined as achieving an aPTT target of more than 45 s at 7 h and 24 h. This clinical trial was registered on clinicaltrials.gov (NCT01734252) and on EudraCT (2012-000487-23). A total of 42 patients, 20 patients in the heparin and 22 in the argatroban group, were included. Of the patients with continued heparin treatment 55% achieved the target aPTT at 7 h, while only 40% of this group maintained the target aPTT after 24 h. Of the argatroban group 59% reached the target aPTT at 7 h, while at 24 h 86% of these patients maintained the targeted aPTT. Treatment success at 7 h did not differ between the groups (p = 0.1000), whereas at 24 h argatroban showed significantly greater efficacy (p = 0.0021) than did heparin. Argatroban also worked better in maintaining adequate anticoagulation in the further course of the study. There was no significant difference in the occurrence of bleeding or thromboembolic complications between the treatment groups. In the case of heparin-resistant critically ill patients, argatroban showed greater efficacy than did an increased dose of heparin in achieving adequate anticoagulation at 24 h and in maintaining the targeted aPTT goal throughout the treatment phase.

scholarly journals Redox Changes Induced by General Anesthesia in Critically Ill Patients with Multiple Traumas

2015 ◽  
Vol 2015 ◽  
pp. 1-11 ◽  
Author(s):  
Marius Papurica ◽  
Alexandru Florin Rogobete ◽  
Dorel Sandesc ◽  
Raluca Dumache ◽  
Radu Nartita ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
General Anesthesia ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Trauma Team ◽  
Multiple Organ ◽  
Cellular Mechanisms ◽  
Surgical Interventions ◽  
Polytrauma Patient ◽  
Multiple Traumas

The critically ill polytrauma patient is a constant challenge for the trauma team due to the complexity of the complications presented. Intense inflammatory response and infections, as well as multiple organ dysfunctions, significantly increase the rate of morbidity and mortality in these patients. Moreover, due to the physiological and biochemical imbalances present in this type of patients, the bioproduction of free radicals is significantly accelerated, thus installing the oxidative stress. In the therapeutic management of such patients, multiple surgical interventions are required and therefore they are being subjected to repeated general anesthesia. In this paper, we want to present the pathophysiological implications of oxidative stress in critically ill patients with multiple traumas and the implications of general anesthesia on the redox mechanisms of the cell. We also want to summarize the antioxidant treatments able to reduce the intensity of oxidative stress by modulating the biochemical activity of some cellular mechanisms.

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