Antioxidant treatment with N-acetylcysteine during adult respiratory distress syndrome: a prospective, randomized, placebo-controlled study.
OBJECTIVE
To examine whether the antioxidant N-acetylcysteine could ameliorate the course of the adult respiratory distress syndrome (ARDS) in man.


METHODS
Randomized, double-blind, placebo-controlled study.


METHODS
Medical and surgical ICU in a regional hospital.


METHODS
Sixty-six ICU patients with ARDS.


METHODS
Patients with ARDS (PaO2/FiO2 ratio less than 250 torr) were treated with either the antioxidant N-acetylcysteine 150 mg/kg as a loading dose and then 20 mg/kg/hr, or with placebo for 6 days.


RESULTS
No improvement could be demonstrated in the PaO2/FiO2 ratio in the study group as compared with the control group on any day. Pulmonary compliance was higher in the N-acetylcysteine group than in the placebo group on all days, but this difference did not reach the chosen 5% level of significance. No difference between the two groups could be demonstrated on chest radiograph or on survival rate. We documented that N-acetylcysteine acts as an anticoagulant and perhaps decreases pulmonary fibrin uptake during ARDS.


CONCLUSIONS
N-acetylcysteine might be of benefit in ARDS. Before further clinical studies are started, problems with N-acetylcysteine and coagulation have to be elucidated in order to find out whether N-acetylcysteine could have a beneficial effect in the treatment of ARDS.
Jepsen
S
S
Department of Anesthesiology and Intensive Care, Aalborg Sygehus, Denmark.
Herlevsen
P
P
Knudsen
P
P
Bud
M I
MI
Klausen
N O
NO
D000111:Acetylcysteine / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000990:Antithrombin III / Q000032:analysis; D004311:Double-Blind Method; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D006801:Humans; D008170:Lung Compliance / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000378:metabolism; D010313:Partial Pressure; D010976:Platelet Count / Q000187:drug effects; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000188:drug therapy*
D000990:Antithrombin III; D005340:Fibrinogen; D010100:Oxygen; D000111:Acetylcysteine