Comparative Study Between Action Vitamin C vs. Action of Nitric Oxide in Prolonged Ventilation in Respiratory Failure Patients Due to ARDS

Abstract

Introduction: Recent meta-analysis prove that vitamin C shorten the duration of mechanical ventilation and accelerate weaning from ventilator especially in prolonged ventilated patients. Nitric oxide considered a relatively old drug used for long time in this issue. Aim: To compare the effect of either vitamin C or nitric oxide on improvement of general condition of the patients, improvement lung mechanics, early weaning from prolonged ventilation and mortality rates. Material and Methods: This a prospective double-blind study done in King Abdul-Aziz specialist hospital between September 2020 and December 2021 in the intensive care unit on 60 patients had difficult weaning after ventilation for >10 days due to Acute Respiratory Distress Syndrome (ARDS) and still showing full criteria of ARDS. Allocated randomly in two groups 30 patients in each. All patients in both groups continued on the same protocol of ventilation. Group A received Nitric Oxide (NO) while group B received vitamin C intravenous. The duration of the study last 16 days. during this period, APCH II score, Hemodynamics, Chest X-ray, hypoxic index, lung compliance, Recruitment maneuver, arterial blood saturation, Lactic Acid Dehydrogenase (LDH), C-reactive protein used as indicator for improvement. Number of patients weaned from the ventilator and patients died also recorded. >Results: Showed significant improvement in the general condition between patients of group B compared to group A which monitored by number of patients had both APACH II score <10 and had normal core temperature. Significant improvement in lung condition between patients of group B compared to group A which monitored clinically by number of patients had arterial oxygen saturation >95, hypoxic index >300, better lung compliance, responder to recruitment maneuver. And monitored radiologically by significant higher number of patients in group B had parenchymatous lung infiltrate in chest X-ray less than one quadrant infiltration compared to group A. And monitored laboratory by significant higher number of patients had lower level of LDH from (100-200 U/L) and CRP (201-300) mg/L in group B compared to group A. There was significant higher number of patients weaned from the ventilator in group B compared to group A. There was significant lower morbidity between patients of group B compared to group A. No significant difference was found in mortality rates. Conclusion: Vitamin C significantly improve the general condition of the patients, improve all parameters of lung mechanics and accelerate weaning from ventilators in prolonged ventilated patients compared to nitric oxide.