DISCUSSION
The first trial, invigorated the possible role of high dose IV ascorbic
acid in critically ill patients, was published by Marik.
(38) Most trials evaluated the role of
oral ascorbic acid in critically ill patients failed to show improved
outcomes due to limited absorption, gut ischemia, impaired intestinal
flora, and different distribution. (39)
Animal models showed that the lungs are very susceptible to ascorbic
acid deficiency. (40) Also, early reports
showed that administration of ascorbic acid was associated with
increased alveolar fluid clearance and decreased epithelial
permeability. These effects were initiated via increased expression of
Na+-K+-ATPase, aquaporin 5, and cystic fibrosis transmembrane
conductance regulator. (41)
To our knowledge, this is the first RCT to investigate the role of high
dose IV ascorbic acid in patients with TRALI in terms of oxidative
stress, pro-inflammatory, and anti-inflammatory markers. Other trials
are still running in patients with close entities for TRALI such as
ARDS, sepsis-induced acute lung injury, and COVID-19 pulmonary
complications.