Histological efficacy of high-dose intravenous vitamin C infusion in severely burned patients

Abstract

Severe burn injuries cause increased endothelial permeability leading to systemic capillary leak and massive fluid shifts into the extravascular space. Excessive fluid resuscitation to ensure sufficient end-organ perfusion results in critical tissue oedema. The present study assessed the underlying microscopic data regarding the integrity of thin skin dermal capillary endothelial barrier and angiogenesis after high-dose vitamin C (HDVC) administration in severely burned patients at days 1, 3 and 7 postburn. Twenty severely burned patients [20% to 25% total body surface area of second deep dermal type] were enrolled in this study. Ten patients received high-dose vitamin C infusion in a dose of 10g within the first 24 h of admission (HDVC burned group) and 10 patients did not (burned group). Patients were selected from the Burn Intensive Care Unit at El-Demerdash Hospital, Ain Shams University. On the microscopic level, HDVC infusion significantly reduced inflammation as evidenced by decreased iNOS immuno-expression and inflammatory cell count, markedly improved tissue barrier function as expressed in enhanced occludin immune-reactivity, significantly decreased the mean area percentage of dermal capillaries, and promoted angiogenesis through increased immuno-expression over time in skin punch biopsies. Overall, HDVC seems promising as an adjunct therapy in burn management, but further investigation is required on clinical grounds to determine the appropriate dose for HDVC infusion and explore its long-term outcome.