Oxidative Stress, Septic Shock
Conditions
Keywords
Oxidative Stress, Sepsis, Treatment, Antioxidant therapy
Brief summary
Sepsis and septic shock are public health problems worldwide that represents an excessive cost for health systems. Despite the great technological and research advances, mortality can reach up to 80% in patients with multiple organ failure (FOM). Therapeutic studies focused on evaluating the usefulness of the use of antioxidants have shown different outcomes and results. This randomized clinical trial in patients with septic shock at two general intensive care units try to evaluate the usefulness of four different antioxidant therapies added to the conventional treatment, which includes: n-acetyl cysteine, vitamin C, vitamin E and melatonin. Measurement of parameters before and after treatment of oxidative stress includes nitrates and nitrites, lipid peroxidation, glutathione peroxidase, glutathione s transferase, extracellular activity of SOD, GSH concentration and evaluation of total antioxidant capacity. The investigators will also evaluate the clinical impact of antioxidant therapy with the SOFA score.
Interventions
DRUGMelatonin 5 mg
Oral: 50 mg once daily for 5 days
DRUGVitamin C 1 GM Oral Tablet
Oral: 1 GM every 6 hours for 5 days
Oral: 400 UNT every 8 hours for 5 days
DRUGN-acetylcysteine
Oral: 1200 mg every 12 hours for 5 days
Sponsors
American British Cowdray Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Diagnosis of septic shock in the last 24 hours characterized by refractory hypotension and vasopressor requirement despite sufficient fluid resuscitation (20 mL/kg of colloids or 40 mL/kg of crystalloids) to maintain a blood pressure ≥ 65 mmHg with a lactate\> 2 mmol/L. * Admitted to the ICU of the ABC Medical Center. * Give informed consent.
Exclusion criteria
* Patients who refuse to be included. * Chronic or recent use of steroids. * Use of statins. * Patients receiving some type of antioxidant treatment. * Any contraindication to the use of vitamin C, vitamin E, n-acetylcysteine or melatonin. * Pregnant women.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Organic failure measurement by the Sequential Organ Failure Assessment Score (SOFA) | Up to 7 days (1 week). From date of randomization and every 24 hours until discharge from the intensive care unit or date of death from any cause, whichever came first, assessed up to 7 days. | The SOFA score is used to track a person's status during the stay in an intensive care unit (ICU) to determine the extent of a person's organ function or rate of failure. The score is based on six different scores, one each for the respiratory, cardiovascular, hepatic, coagulation, renal and neurological systems. Each organ system is assigned a point value from 0 (normal) to 4 (high degree of dysfunction/failure). The worst physiological variables is collected serially every 24 hours of a patient's ICU admission. The worst measurement is defined as the measure that correlated to the highest number of points. The SOFA score ranges from 0 to 24. The investigators are going to evaluate the daily total score and the trend before and after the administration of the therapy. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Glutathione Peroxidase Enzyme Activity | Immediately before treatment and 48 hours after therapy | Antioxidant status |
| Glutathione concentration | Immediately before treatment and 48 hours after therapy | Antioxidant status |
| Selenium | Immediately before treatment and 48 hours after therapy | Antioxidant status |
| Vitamin C | Immediately before treatment and 48 hours after therapy | Antioxidant status |
| Thioredoxin | Immediately before treatment and 48 hours after therapy | Antioxidant status |
| Carbonylation | Immediately before treatment and 48 hours after therapy | Pro-oxidant status |
| Nitrates and nitrites levels | Immediately before treatment and 48 hours after therapy | Oxidative stress |
| Malondialdehyde levels | Immediately before treatment and 48 hours after therapy | Lipid peroxidation |
| Total antioxidant capacity | Immediately before treatment and 48 hours after therapy | Antioxidant status |
| Glutathione S-transferase Activity | Immediately before treatment and 48 hours after therapy | Antioxidant status |
| Extracellular Superoxide Dismutase Activity | Immediately before treatment and 48 hours after therapy | Antioxidant status |
Other
| Measure | Time frame | Description |
|---|---|---|
| IL-6 | Immediately before treatment and 48 hours after therapy | Inflammatory Response Pathway |
| Ionized Ca2+ | Immediately before treatment and 48 hours after therapy | Electrolytes |
| Ionized Mg2+ | Immediately before treatment and 48 hours after therapy | Electrolytes |
| IL-1 | Immediately before treatment and 48 hours after therapy | Inflammatory Response Pathway |
| TNF-α | Immediately before treatment and 48 hours after therapy | Inflammatory Response Pathway |
Countries
Mexico
Outcome results
None listed