Vitamin E Supplementation in Burn Patients

• Alpha-Tocopherol in Plasma, Adipose (also: Lung, Skin, Muscle, Liver in the case of Death) [ Time Frame: 30 Days ] [ Designated as safety issue: No ]
  
• Gamma-Tocopherol in Plasma, Adipose (also: Lung, Skin, Muscle, Liver in the case of Death) [ Time Frame: 30 Days ] [ Designated as safety issue: No ]
  
• Vitamin E Metabolites in Plasma, Urine [ Time Frame: 30 Days ] [ Designated as safety issue: No ]
  
• Malondialdehyde in Plasma, Urine (also: Lung, Skin, Muscle in the case of Death) [ Time Frame: 30 Days ] [ Designated as safety issue: No ]
  
• Isoprostanes in Plasma, Urine (also: Lung, Skin, Muscle in the case of Death) [ Time Frame: 30 Days ] [ Designated as safety issue: No ]
  
• Lipid Panel in Plasma and Triglyceride Concentration [ Time Frame: 30 Days ] [ Designated as safety issue: No ]
  
• Liver Ultrasound [ Time Frame: 30 Days ] [ Designated as safety issue: No ]
  
• Pulmonary Function Study Variables [ Time Frame: 30 Days ] [ Designated as safety issue: No ]
  
• Cardiopulmonary Stress Test [ Time Frame: 30 Days ] [ Designated as safety issue: No ]
  

• Open Body Surface Area and Wound Healing [ Time Frame: 30 Days ] [ Designated as safety issue: No ]
  
• Weight [ Time Frame: 30 Days ] [ Designated as safety issue: No ]
  
• Basal Metabolic Rate [ Time Frame: 30 Days ] [ Designated as safety issue: No ]
  
• Diet History and Food Intake [ Time Frame: 30 Days ] [ Designated as safety issue: No ]
  
• Fluid Balance [ Time Frame: 30 Days ] [ Designated as safety issue: No ]
  
• Incidence of Acute Respiratory Distress Syndrome (ARDS) [ Time Frame: 30 Days ] [ Designated as safety issue: No ]
  
• Incidence of Pneumonia [ Time Frame: 30 Days ] [ Designated as safety issue: No ]
  
• Incidence of Atelectasis [ Time Frame: 30 Days ] [ Designated as safety issue: No ]
  
• Ventilator Variables (Compliance, Resistance, Work of Breathing, Number of Days Ventilated) [ Time Frame: 30 Days ] [ Designated as safety issue: No ]
  
• Pulmonary Status Variables (Spirometry, Blood Gas, Diffusion Constant, Pulmonary Capillary Surface Area) [ Time Frame: 30 Days ] [ Designated as safety issue: No ]
  

We have previously demonstrated that thermal injury depletes plasma vitamin E in pediatric burn patients. However, plasma changes reflect short-term vitamin E changes, whereas adipose tissue alpha-tocopherol concentrations reflect long-term vitamin E status. We reported last year that burn injury depleted vitamin E stores in adipose tissue in children by nearly half within one month following injury. Our long-term goal is to improve the quality of life of burn patients by preventing pulmonary and hepatic dysfunction that may occur from vitamin E depletion. The objectives of this application are to a) attenuate alpha-tocopherol depletion in burned patients by vitamin E supplementation, b) prevent or reverse oxidative stress in these patients, and c) collect pilot data on the effect of vitamin E supplementation on lung and liver function. Our central hypothesis is that the administration of high doses of alpha-tocopherol will prevent or restore levels of vitamin E in adipose tissue and reverse the oxidative state in burned patients. The rationale of the proposed studies is that in severe cases of vitamin E depletion, oxidative stress, fatty liver and lung dysfunction have all been reported in our patients. We will administer vitamin E supplements (300-1200 IU RRR-alpha-tocopherol) to burn subjects (n= 20 per group, 6-70 years, ≥20% total body surface burns) for fifteen days. The subjects will be randomly assigned into two groups: an early treatment group who will receive vitamin E for days 1-15 of the study, and a delayed treatment group who will receive vitamin E for days 16-30 of the study. Both groups will be studied for a total of thirty days. We will test the following aims: Aim 1: determine the degree that supplemental Vitamin E will attenuate alpha-tocopherol depletion. Aim 2: determine if supplemental Vitamin E reduces markers of oxidative stress in burned patients. Aim 3: collect preliminary data to establish the relationship between oxidative stress and pulmonary pathophysiology and fatty liver after burn injury. We will measure plasma and adipose tissue alpha-tocopherol and urinary and plasma markers of oxidative stress, prior to supplementation and then weekly. The proposed research is innovative because the oxidative stress of burn injury causes a severe depletion of an essential nutrient, vitamin E. Supplementation of vitamin E is a novel concept that may mitigate the complications of burns, including lung injury, fatty liver and peripheral neuropathy.