THE EFFECTS OF INTRAVENOUS ANTIOXIDANTS IN PATIENTS WITH SEPTIC SHOCK

Oxidative stress is implicated in septic shock. We investigated the ef fect of intravenous antioxidant therapy on antioxidant status, lipid p eroxidation, hemodynamics and nitrite in patients with septic shock. T hirty patients randomly received either antioxidants (n-acetylcysteine 150 mg/kg for 30 min then 20 mg/kg/h plus bolus doses of 1 g ascorbic acid and 400 mg alpha-tocopherol) or 5% dextrose. Basal vitamin C was low and redox-reactive iron was elevated in all patients. In the 16 p atients receiving antioxidants, vitamin C increased (p=.0002) but tota l antioxidant capacity was unaffected. Lipid peroxides were elevated i n all pateints but did not increase further in the patients receiving antioxidants. Plasma total nitrite also increased (p=.007) in the anti oxidant group. Heart rate increased in patients receiving antioxidants at 60 min (p=.018) and 120 min (p=.004). Cardiac index also increased at 60 min (p=.007) and 120 min (p=.05). Systemic vascular resistance index decreased at 120 min in the antioxidant treated patients (p=.003 ). The effect of antioxidants on hemodynamic variables has not previou sly been reported. Antioxidant administration may be a useful adjunct to conventional approaches in the management of septic shock. (C) 1997 Elsevier Science Inc.