title: A trial of antioxidants N-acetylcysteine and procysteine in ARDS. The Antioxidant in ARDS Study Group.
abstract: OBJECTIVE
  To determine the levels of glutathione and cysteine in patients with ARDS and examine the effect of treatment with N-acetylcysteine (NAC) and L-2-oxothiazolidine-4-carboxylate (Procysteine; Clintec Technologies Inc; Chicago [OTZ]) on these levels and on common physiologic abnormalities, and organ dysfunction associated with ARDS.
  
  
  METHODS
  Randomized, double-blind, placebo-controlled, prospective clinical trial.
  
  
  METHODS
  ICUs in five clinical centers in the United States and Canada.
  
  
  METHODS
  Patients meeting a predetermined definition of ARDS and requiring mechanical ventilation.
  
  
  METHODS
  Standard care for ARDS and I.V. infusion, every 8 h for 10 days, of one of the following: NAC (70 mg/kg, n=14), OTZ (63 mg/kg, n=17), or placebo (n=15).
  
  
  RESULTS
  Both antioxidants effectively repleted RBC glutathione gradually over the 10-day treatment period (47% and 49% increases from baseline values for NAC and OTZ, respectively). There was no difference in mortality among groups (placebo, 40%; NAC, 36%; OTZ, 35%). However, the number of days of acute lung injury was decreased and there was also a significant increase in cardiac index in both treatment groups (NAC/OTZ [+]14%; placebo [-]6%).
  
  
  CONCLUSIONS
  Our findings suggest that repletion of glutathione may safely be accomplished with NAC or OTZ in patients with acute lung injury/ARDS. Such treatment may shorten the duration of acute lung injury, but larger studies are needed to confirm this.
authors.affiliation: Center for Lung Research, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tenn, USA.
authors.forename: G R
authors.initials: GR
authors.lastname: Bernard
authors.forename: A P
authors.initials: AP
authors.lastname: Wheeler
authors.forename: M M
authors.initials: MM
authors.lastname: Arons
authors.forename: P E
authors.initials: PE
authors.lastname: Morris
authors.forename: H L
authors.initials: HL
authors.lastname: Paz
authors.forename: J A
authors.initials: JA
authors.lastname: Russell
authors.forename: P E
authors.initials: PE
authors.lastname: Wright
mesh_terms: D000111:Acetylcysteine / Q000627:therapeutic use*; D000328:Adult; D000975:Antioxidants / Q000627:therapeutic use; D001663:Bilirubin / Q000097:blood; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology; D002302:Cardiac Output; D003545:Cysteine / Q000097:blood; D004311:Double-Blind Method; D016166:Free Radical Scavengers / Q000627:therapeutic use*; D005978:Glutathione / Q000097:blood; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D011761:Pyrrolidonecarboxylic Acid; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000188:drug therapy* / Q000503:physiopathology / Q000628:therapy; D013844:Thiazoles / Q000627:therapeutic use*; D053778:Thiazolidines; D013997:Time Factors
chemical_list: D000975:Antioxidants; D016166:Free Radical Scavengers; D013844:Thiazoles; D053778:Thiazolidines; D005978:Glutathione; D003545:Cysteine; D001663:Bilirubin; D011761:Pyrrolidonecarboxylic Acid; D000111:Acetylcysteine; C029536:2-oxothiazolidine-4-carboxylic acid