Vitamin E attenuates acute lung injury in sheep with burn and smoke inhalation injury

Introduction: A decrease in a-tocopherol ( vitamin E) plasma levels in burn patients is typically associated with increased mortality. We hypothesized that vitamin E supplementation (alpha-tocopherol) would attenuate acute lung injury induced by burn and smoke inhalation injury. Materials and Methods: Under deep anesthesia, sheep ( 33 5 kg) were subjected to a flame burn ( 40% total body surface area, third degree) and inhalation injury ( 48 breaths of cotton smoke, < 40 degrees C). Half of the injured group received alpha-tocopherol (1000 IU vitamin E) orally, 24 h prior to injury. The sham group was neither injured nor given vitamin E. All three groups (n = 5 per group) were resuscitated with Ringer's lactate solution ( 4 ml/kg/%burn/24 h), and placed on a ventilator ( PEEP = 5 cmH(2)O; tidal volume = 15 ml/ kg) for 48 h. Results: Plasma a-tocopherol per lipids doubled in the vitamin E treated sheep. Vitamin E treatment prior to injury largely prevented the increase in pulmonary permeability index and moderated the increase in lung lymph flow (52.6 +/- 6.2 ml/ min, compared with 27.3 +/- 6.0 ml/ min, respectively), increased the PaO2/FiO(2) ratio, ameliorated both peak and pause airway pressure increases, and decreased plasma conjugated dienes and nitrotyrosine. Conclusions: Pretreatment with vitamin E ameliorated the acute lung injury caused by burn and smoke inhalation exposure.