Intravenous vitamin C in critically ill adult patients with burns: An integrative review

Early fluid resuscitation may cause fluid overload in seriously ill burn patients, which is associated with losses of micronutrients and poor clinical outcomes. Over the past two to three decades, several animal studies and clinical trials have demonstrated that high-dose intravenous vitamin C may reduce fluid requirements, body weight gain, and wound edema, improving gas exchange and renal function in the acute phase after burn injury. Vitamin C is a scavenger of oxygen free radicals in the endothelium, which can limit the inflammatory response and ischemia-reperfusion injury, promoting wound healing. Nonetheless, current knowledge is not entirely conclusive. Research that leads to a better understanding of the vitamin's pharmacokinetics/dynamics is a first requirement before embarking on well-powered, well-designed clinical trials that still need to be conducted. This review aims to summarize vitamin C status in burn patients and its biological properties, in order to evaluate the rationale and most current evidence for routine supplementation, as recommended by current clinical guidelines, and the potential for high-dose vitamin C as a pharmaconutrient in critically ill burn patients.