title: N-Acetylcysteine's Role in Sepsis and Potential Benefit in Patients With Microcirculatory Derangements.
abstract: OBJECTIVE
  To review the data surrounding the utility of N-acetylcysteine (NAC) in sepsis and identify areas needed for additional research.
  
  
  METHODS
  A review of articles describing the mechanisms of action and clinical use of NAC in sepsis.
  
  
  RESULTS
  Despite many advances in critical care medicine, still as many as 50% of patients with septic shock die. Treatments thus far have focused on resuscitation and restoration of macrocirculatory targets in the early phases of sepsis, with less focus on microcirculatory dysfunction. N-acetylcysteine, due to its anti-inflammatory and antioxidative properties, has been readily investigated in sepsis and has yielded largely incongruous and disappointing results. In addition to its known anti-inflammatory and antioxidative roles, one underappreciated property of NAC is its ability to vasodilate the microcirculation and improve locoregional blood flow. Some investigators have sought to capitalize on this mechanism with promising results, as evidenced by microcirculatory vasodilation, improvements in regional blood flow and oxygen delivery, and reductions in lactic acidosis, organ failure, and mortality.
  
  
  CONCLUSIONS
  In addition to its antioxidant and anti-inflammatory properties, N-acetylcysteine possesses vasodilatory properties that could benefit the microcirculation in sepsis. It is imperative that we investigate these properties to uncover NAC's full potential for benefit in sepsis.
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Florida College of Medicine, Gainesville, FL, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Chertoff
mesh_terms: D000111:Acetylcysteine / Q000627:therapeutic use*; D000140:Acidosis, Lactic / Q000209:etiology; D016166:Free Radical Scavengers / Q000627:therapeutic use*; D006801:Humans; D008833:Microcirculation / Q000502:physiology*; D009026:Mortality; D009102:Multiple Organ Failure / Q000209:etiology; D012039:Regional Blood Flow; D018805:Sepsis / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D014664:Vasodilation
chemical_list: D016166:Free Radical Scavengers; D000111:Acetylcysteine
keywords: N-acetylcysteine; microcirculation; microvascular; sepsis; septic shock; vasodilation