Vitamine C pour la coagulopathie du traumatisé sévère

Interventional Vitamin C: A Strategy for Attenuation of Coagulopathy and Inflammation in a Swine Polytrauma Model

Reynolds PS et Al. J Trauma Acute Care Surg. 2018 DOI:10.1097/TA.0000000000001844

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L'emploi de vitamine C à haute dose est connue dans le cadre de la réanimation du brûlé (1). Elle limiterait la fuite capillaire du fait de propriétés anti-oxydantes. Les auteurs rapportent un intérêt expérimental modéré mais prometteur à leur avis.

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BACKGROUND

Coagulopathy and inflammation induced by hemorrhagic shock and traumatic injury are associated with increased mortality and morbidity. Vitamin C (VitC) is an antioxidant with potential protective effects on the pro-inflammatory and pro-coagulant pathways. We hypothesized that high-dose VitC administered as a supplement to fluid resuscitation would attenuate inflammation, coagulation dysfunction, and end-organ tissue damage in a swine model of polytrauma and hemorrhage.

METHODS

Male Sinclair swine (n = 24; mean body weight 27 kg) were anesthetized, intubated, mechanically ventilated, and instrumented for physiological monitoring. Following stabilization, swine were subjected to shock/traumatic injury (hypothermia, liver ischemia and reperfusion, comminuted femur fracture, hemorrhagic hypotension), resuscitated with 500mL of hydroxyethyl starch, and randomized to receive either intravenous saline (NS), low dose VitC (50mg/kg; LO), or high dose VitC (200 mg/kg; HI). Hemodynamics, blood chemistry, hematology, and coagulation function (ROTEM) were monitored to 4 hours post-resuscitation. Histological and molecular analyses were obtained for liver, kidney, and lung.

RESULTS

Compared to VitC animals, NS swine showed significant histological end-organ damage, elevated acute lung injury scores, and increased mRNA expression of tissue pro-inflammatory mediators (IL-1, IL-8, TNF), PAI-1, and TF. There were no statistically significant differences between treatment groups on MAP or univariate measures of coagulation function; however, NS showed impaired multivariate clotting function at 4 hours.

CONCLUSIONS

Although correction of coagulation dysfunction was modest, intravenous high-dose VitC may mitigate the pro-inflammatory/pro-coagulant response that contributes to multiple organ failure following acute severe polytrauma.