title: The immunological benefit of higher dose N-acetyl cysteine following mechanical ventilation in critically ill patients.
abstract: BACKGROUND
  Sepsis complication is a major cause of death in multiple trauma critically ill patients. Defensin (cysteine rich anti-microbial peptides), as an important component of immune system, might play an important role in this process. There is also rising data on immunological effects of N-acetyl-cysteine (NAC), a commonly used anti-oxidant in oxidative stress conditions and glutathione (GSH) deficiencies. The aim of the present study was to evaluate the potential beneficial effects of NAC administration on multiple trauma patients with sepsis.
  
  
  METHODS
  In a prospective, randomized controlled study, 44 multiple trauma critically ill patients who were mechanically ventilated and met the criteria of sepsis and admitted to the intensive care unit (ICU) were randomized into two groups . Control group received all standard ICU therapies and NAC group received intravenous NAC 3 gr every 6 hours for 72 hours in addition to standard therapies. Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores, length of ICU stay, ICU mortality were recorded. Levels of serum Immunoglobulin M (IgM), Human β-Defensin 2 (HβD2) and GSH were assessed at baseline and 24, 72, 120 hours after intervention.
  
  
  RESULTS
  During a period of 13-month screening, 44 patients underwent randomization but 5 patients had to be excluded. 21 patients in NAC group and 18 patients in control group completed the study. For both groups the length of ICU stay, SOFA score and systemic oxygenation were similar. Mortality rate (40% vs. 22% respectively, p = 0.209) and ventilator days (Mean ± SD 19.82 ± 19.55 days vs. 13.82 ± 11.89 days respectively, p = 0.266) were slightly higher for NAC group. IgM and GSH levels were similar between two groups (p = 0.325, 0.125 respectively), HβD2 levels were higher for NAC group (at day 3).
  
  
  CONCLUSIONS
  High dose of NAC administration not only did not improve patients' outcome, but also raised the risk of inflammation and was associated with increased serum creatinine.
authors.forename: Atabak
authors.initials: A
authors.lastname: Najafi
authors.forename: Mojtaba
authors.initials: M
authors.lastname: Mojtahedzadeh
authors.forename: Keyvan Haji
authors.initials: KH
authors.lastname: Ahmadi
authors.forename: Mohammad
authors.initials: M
authors.lastname: Abdollahi
authors.forename: Maryam
authors.initials: M
authors.lastname: Mousavi
authors.forename: Legese
authors.initials: L
authors.lastname: Chelkeba
authors.forename: Farhad
authors.initials: F
authors.lastname: Najmeddin
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Sina Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran. aarezoo24@gmail.com.
authors.forename: Arezoo
authors.initials: A
authors.lastname: Ahmadi
mesh_terms: D018806:APACHE; D000111:Acetylcysteine / Q000008:administration & dosage*; D000328:Adult; D000975:Antioxidants / Q000008:administration & dosage; D003404:Creatinine / Q000097:blood; D016638:Critical Illness; D005260:Female; D005978:Glutathione / Q000097:blood; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D007362:Intensive Care Units; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000097:blood / Q000188:drug therapy*; D063305:Organ Dysfunction Scores; D012121:Respiration, Artificial; D018805:Sepsis / Q000097:blood / Q000188:drug therapy*; D055815:Young Adult; D023083:beta-Defensins / Q000097:blood
chemical_list: D000975:Antioxidants; C106641:DEFB4A protein, human; D007075:Immunoglobulin M; D023083:beta-Defensins; D003404:Creatinine; D005978:Glutathione; D000111:Acetylcysteine