Vitamin E supplementation in the critically ill patient: too narrow a view?

Oxidative stress plays an important contributory role in a number of diseases. In critically ill patients, oxidative stress is a major problem that results from a number of compounding factors such as supportive oxygen therapy, pulmonary inflammation, and the nutritional inadequacies of these patients. It has been known for some time that the circulating concentration of vitamin E, the primary lipid-soluble antioxidant, is low in critically ill patients. However, supplementation with vitamin E by oral loading has not been successful in improving clinical status. A better understanding of the bioavailability of vitamin E in these patients and of the synergistic action of other antioxidant nutrients such as vitamin C and glutathione with vitamin E has provided new opportunities to reexamine the use of antioxidant supplementation for the critically ill.