Describing the influences of inflammation on host oxidant production and antioxidant defense mechanisms have been extremely important in our understanding of ALI/ARDS. However, treatment strategies have fallen short secondary to their simplicity. As well, there is a paucity of data in this area. Eight patients with ARDS receiving “standardized” total parenteral nutrition were investigated56and compared to 17 healthy individuals who served as control subjects in an attempt to assess the influence of micronutrients on the oxidative system. The measurements of plasma antioxidants and antioxidant enzyme systems were measured at baseline and on days 3 and 6, and were compared to those of control subjects who were receiving standard diets without vitamin or trace element supplementation. In addition, the lipid peroxidation product, malondialdehyde (MDA), O2.− anion, and H2O2 were measured over the same time points. Plasma levels of α-tocopherol, ascorbate, β-carotene, and selenium were reduced when compared to those of control subjects. MDA was significantly increased and was observed to increase significantly over the 6-day interval. The authors concluded that in patients with ARDS, the antioxidative system is severely compromised and there is evidence of progressive oxidant stress, as per the steady increase in MDA. Thus, the administration of standardized total parenteral nutrition seems inadequate to compensate for the increased requirements. In a contrasting study, when patients with ARDS were entered into a prospective, multicentered, double-blind, randomized control trial comparing a specialized enteral formulation containing fish, borage oil, and elevated antioxidants vs an isonitrogenous, isocaloric standard diet, beneficial anti-inflammatory effects were observed that translated into reductions in the number of days spent receiving mechanical ventilation, in the lengths of stay in the ICU, and in instances of new organ failure.57 The formulation administered over an interval of 4 to 7 days, which included eicosapentaenoic acid (ie, fish oil), γ-linolenic acid (ie, borage seed oil), and antioxidants (ie, vitamin A, α-tocopherol, ascorbate, and β-carotene) significantly increased the Pao2/fraction of inspired oxygen ratio, decreased the production of neutrophils in the BALF, and decreased the total cell count in the BALF when compared to the control group. Oxidants and antioxidants per se were not directly measured, but a decrease in pulmonary inflammation with reduced neutrophil adhesion and oxidant production was observed.