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The critically ill patient is undergoing episodes of ischemia reperfusion, systemic inflammatory response syndrome, sepsis and multiorgan failure. These episodes are associated with lower levels of antioxidants in specific populations such as acute pancreatitis, head trauma, acute respiratory distress syndrome (ARDS) or acute lung injury patients. This review will deal with the definition of oxidative stress, the reactive oxygen species that are produced by the tissues during the oxidative stress, the antioxidant capacity of the ICU patients, but also the role of the glucose control in the regulation of anti oxidant therapy in addition to trace elements, vitamins and Nacetyl-cysteine. A special accent will be given to supplements such as polyphenols for the prevention and the therapy of oxidative stress in specific situations such as organ transplantation or hemorrhagic shock.