Effect of Antioxidant Vitamins on Coagulopathy and Nosocomial Pneumonia After Severe Trauma
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Study Type
Study Type
Enrollment (Actual)
Enrollment
Phase
Phase
- Phase 2
Contacts and Locations
Study Locations
-
-
Alabama
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Birmingham, Alabama, United States, 35294
- The University of Alabama at Birmingham Hospital
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-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Adult trauma patients admitted to the emergency department at the University of Alabama at Birmingham (UAB) Hospital
- Blunt or penetrating injury
- UAB highest trauma activation
Exclusion Criteria:
- Age < 19 years of age
- Patients with known bleeding diathesis or who are concurrently taking anticoagulant medication
- Patients with known liver disease
- Minor patients
- Pregnant patients (known or suspected pregnancy)
- Patients who are incarcerated
- Patients who lack a surrogate
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Experimental: Vitamins C and E
Vitamin C (1,000 mg i.v.) and Vitamin E (1,000 IU p.o. via the naso-gastric tube) administered every 8 hours starting within one hour after admission to the Emergency department for up to 5 days or until discharge from the ICU, whichever comes first.
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Other Names:
Other Names:
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Placebo Comparator: 0.9% saline and sugar pill
100 ml of 0.9% saline (for i.v.
Vitamin C) and a p.o. placebo (sugar pill for the p.o. Vitamin E) administered every 8 hours starting within one hour after admission to the Emergency department for up to 5 days or until discharge from the ICU, whichever comes first.
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0.9% saline administered to mimic Vitamin C
Sugar pill administered to mimic Vitamin E
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What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Number of Participants With Coagulation Abnormalities
Time Frame: From enrollment up to 3 days
|
Coagulation parameters are evaluated using standard functional tests (prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen and platelet count)and point of care functional analysis using thromboelastogram (TEG-ROTEM).
A blood sample is collected upon arrival in the emergency department at 0 hours only and analyzed for markers of activation of coagulation, inflammation, and levels of vitamin C/E.
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From enrollment up to 3 days
|
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Number of Subjects With Ventilator-associated Pneumonia.
Time Frame: From enrollment to 3 days
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Number of subjects diagnosed with pneumonia and requiring ventilator support.
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From enrollment to 3 days
|
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Number of Subjects With Organ Injury
Time Frame: From enrollment to 3 days
|
Any injury to internal organs (thoracic, abdominal or cranial cavity)
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From enrollment to 3 days
|
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Number of Total Blood Product Transfusions
Time Frame: From enrollment to 3 days
|
the number of blood product transfusions for all subjects in each group over the course of 3 days.
|
From enrollment to 3 days
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Number of Protocol Violations Per Arm.
Time Frame: from enrollment up to 60 days post enrollment
|
The number of times that there was a deviation or violation from how the protocol was to be implemented.
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from enrollment up to 60 days post enrollment
|
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Number of Subjects Surviving to Day 28
Time Frame: from enrollment up to 28 days post enrollment
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Number of subjects that survived to day 28 after enrollment
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from enrollment up to 28 days post enrollment
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Number of Subjects With 60-day Survival
Time Frame: from enrollment up to 60 days post enrollment
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Number of subjects in each arm that survived to day 60
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from enrollment up to 60 days post enrollment
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Mean Number of Ventilator-free Days for Subjects
Time Frame: from enrollment up to 60 days post enrollment
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The mean number of ventilator free days (not on ventilator) for subjects in each arm
|
from enrollment up to 60 days post enrollment
|
|
Mean Number of Days in ICU.
Time Frame: from enrollment up to 60 days post enrollment
|
the mean number of days each subject was in the ICU in each arm
|
from enrollment up to 60 days post enrollment
|
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Mean Number of Hospital Stay Days.
Time Frame: from enrollment up to 60 days post enrollment
|
The mean number of days subjects were in the hospital in each arm of the study
|
from enrollment up to 60 days post enrollment
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Collaborators and Investigators
Sponsor
Sponsor
Investigators
Investigators
- Principal Investigator: Jean-Francois Pittet, M.D., The University of Alabama at Birmingham
- Principal Investigator: Jeffrey Kerby, M.D., Ph.D., The University of Alabama at Birmingham
Publications and helpful links
General Publications
- Giladi AM, Dossett LA, Fleming SB, Abumrad NN, Cotton BA. High-dose antioxidant administration is associated with a reduction in post-injury complications in critically ill trauma patients. Injury. 2011 Jan;42(1):78-82. doi: 10.1016/j.injury.2010.01.104. Epub 2010 Feb 10.
- Nathens AB, Neff MJ, Jurkovich GJ, Klotz P, Farver K, Ruzinski JT, Radella F, Garcia I, Maier RV. Randomized, prospective trial of antioxidant supplementation in critically ill surgical patients. Ann Surg. 2002 Dec;236(6):814-22. doi: 10.1097/00000658-200212000-00014.
- Collier BR, Giladi A, Dossett LA, Dyer L, Fleming SB, Cotton BA. Impact of high-dose antioxidants on outcomes in acutely injured patients. JPEN J Parenter Enteral Nutr. 2008 Jul-Aug;32(4):384-8. doi: 10.1177/0148607108319808.
- Brohi K, Singh J, Heron M, Coats T. Acute traumatic coagulopathy. J Trauma. 2003 Jun;54(6):1127-30. doi: 10.1097/01.TA.0000069184.82147.06.
- Brohi K, Cohen MJ, Ganter MT, Schultz MJ, Levi M, Mackersie RC, Pittet JF. Acute coagulopathy of trauma: hypoperfusion induces systemic anticoagulation and hyperfibrinolysis. J Trauma. 2008 May;64(5):1211-7; discussion 1217. doi: 10.1097/TA.0b013e318169cd3c.
- MacLeod JB, Lynn M, McKenney MG, Cohn SM, Murtha M. Early coagulopathy predicts mortality in trauma. J Trauma. 2003 Jul;55(1):39-44. doi: 10.1097/01.TA.0000075338.21177.EF.
- Brohi K, Cohen MJ, Ganter MT, Matthay MA, Mackersie RC, Pittet JF. Acute traumatic coagulopathy: initiated by hypoperfusion: modulated through the protein C pathway? Ann Surg. 2007 May;245(5):812-8. doi: 10.1097/01.sla.0000256862.79374.31.
- Chesebro BB, Rahn P, Carles M, Esmon CT, Xu J, Brohi K, Frith D, Pittet JF, Cohen MJ. Increase in activated protein C mediates acute traumatic coagulopathy in mice. Shock. 2009 Dec;32(6):659-65. doi: 10.1097/SHK.0b013e3181a5a632.
- Cohen MJ, Bir N, Rahn P, Dotson R, Brohi K, Chesebro BB, Mackersie R, Carles M, Wiener-Kronish J, Pittet JF. Protein C depletion early after trauma increases the risk of ventilator-associated pneumonia. J Trauma. 2009 Dec;67(6):1176-81. doi: 10.1097/TA.0b013e3181c1c1bc.
- Secor D, Li F, Ellis CG, Sharpe MD, Gross PL, Wilson JX, Tyml K. Impaired microvascular perfusion in sepsis requires activated coagulation and P-selectin-mediated platelet adhesion in capillaries. Intensive Care Med. 2010 Nov;36(11):1928-34. doi: 10.1007/s00134-010-1969-3. Epub 2010 Aug 6.
- Esmon CT. The protein C pathway. Chest. 2003 Sep;124(3 Suppl):26S-32S. doi: 10.1378/chest.124.3_suppl.26s.
Study record dates
Study Major Dates
Study Start
Study Start
Primary Completion (Actual)
Primary Completion
Study Completion (Actual)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Estimate)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Pathologic Processes
- Cardiovascular Diseases
- Vascular Diseases
- Infections
- Respiratory Tract Infections
- Respiratory Tract Diseases
- Lung Diseases
- Disease Attributes
- Hematologic Diseases
- Hemorrhagic Disorders
- Cross Infection
- Iatrogenic Disease
- Hemostatic Disorders
- Blood Coagulation Disorders
- Healthcare-Associated Pneumonia
- Pneumonia
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Protective Agents
- Micronutrients
- Antioxidants
- Vitamin E
- Tocopherols
- alpha-Tocopherol
- Vitamins
- Tocotrienols
- Ascorbic Acid
Other Study ID Numbers
Other Study ID Numbers
- F101108001
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