title: N-Acetylcysteine administered as part of the immediate post-traumatic resuscitation regimen does not significantly influence initiation of inflammatory responses or subsequent endotoxin hyporesponsiveness.
abstract: Polytrauma and resuscitative efforts induce extensive alterations in the host's internal environment and cellular responses that may be a serious threat to these patients. Administration of exogenous thiols has been recommended to modulate the post-traumatic inflammatory responses. In this study, we have investigated the effect of N-acetylcysteine (NAC) on the early markers of leukocyte activation and subsequent endotoxin hyporesponsiveness. Twenty-eight pigs were exposed to a standardized gunshot injury. First aid treatment and initial life saving surgery was started without delay. One group (n = 14) was randomised to receive NAC 200 mg kg(-1) over 20 min, the remaining group was given the same volume of vehicle. Blood samples drawn at time points 0 and 75 min were also studied in vitro and stimulated with LPS or LPS plus NAC. Selected physiologic variables and degree of organ injury were equal in both groups. TNF-alpha, IL-1beta, and reactive oxygen species (ROS) tended to be lower in the NAC-group (NS). In vitro, NAC significantly reduced the release of the same cytokines after the LPS challenge in blood drawn before injury. NAC did not influence post-traumatic endotoxin tolerance. Adding NAC to the immediate resuscitation fluid did not influence the early post-traumatic organ injury, and initiation of inflammatory responses significantly, or endotoxin tolerance. In vitro, NAC significantly reduced proinflammatory cytokine release, but only in normal blood. The clinical value of this treatment regimen is probably restricted, both due to the unfavourable post-traumatic internal environment and imposed dosing limitations.
authors.affiliation: Norwegian Defence Research Establishment, POB 25, N-2027 Kjeller, Norway. yngvar.gundersen@ffi.no
authors.forename: Yngvar
authors.initials: Y
authors.lastname: Gundersen
authors.forename: Per
authors.initials: P
authors.lastname: Vaagenes
authors.forename: Ingjerd
authors.initials: I
authors.lastname: Thrane
authors.forename: Sigrun H
authors.initials: SH
authors.lastname: Sterri
authors.forename: Per Kristian
authors.initials: PK
authors.lastname: Opstad
mesh_terms: D000111:Acetylcysteine / Q000008:administration & dosage / Q000627:therapeutic use*; D000818:Animals; D004731:Endotoxins / Q000097:blood; D007249:Inflammation / Q000097:blood / Q000209:etiology; D007375:Interleukin-1 / Q000097:blood; D007962:Leukocytes; D009504:Neutrophils; D009664:Norway; D017382:Reactive Oxygen Species / Q000097:blood; D012151:Resuscitation; D013552:Swine; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis; D014947:Wounds and Injuries / Q000097:blood / Q000276:immunology / Q000628:therapy*
chemical_list: D004731:Endotoxins; D007375:Interleukin-1; D017382:Reactive Oxygen Species; D014409:Tumor Necrosis Factor-alpha; C044101:endotoxin, Escherichia coli; D000111:Acetylcysteine