Effect of N-acetylcystein on pulmonary function in patients undergoing off-pump coronary artery bypass surgery

Abstract

NAC demonstrated promising results in terms of mitigating the increase in PVRI during mechanical heart displacement and attenuating the development of acute lung injury in the immediate post-operative period. However, NAC could not induce a definite improvement in the other important pulmonary variables including PaO(2)/FiO(2) and Q(s)/Q(t), and did not lead to a decreased duration of ventilatory care or length of stay in the intensive care unit.

Efficacy of N-acetylcysteine in preventing atrial fibrillation after cardiac surgery: a meta-analysis of published randomized controlled trials

“…The number of patients ranged from 20 [19,20] to 240 [16]. Of the 10 RCTs, five trials were conducted in Turkey [12,19-22], two in Canada [23,24], one in Iran [16], one in Germany [25], and one in Korea [26]. With the use of Jadad 5 point score, all studies were considered high quality.…”

“…Five trials [19,20,22,24,26] enrolled 228 patients undergoing CABG only, and the remaining 5 trials [12,16,21,23,25] included 798 patients undergoing valve surgery or combination valve surgery with CABG. NAC administration regimen is also presented in detail in Table 1, with 8 studies [12,19-23,25,26] using intravenous administration and 2 studies [16,24] using oral administration before cardiac surgery. The duration of NAC administration after cardiac surgery varied from 4 hours [23] to 72 hours [16].…”

“…We tested whether excluding small sample studies (n <60 patients) [19,20,22,26] would change the direction of the overall result. The meta-analysis of the remaining studies (OR 0.57, 95% CI 0.40 to 0.80; P  = 0.001) [12,16,21,23-25] was similar to the overall result, with little statistical heterogeneity (I 2  = 42%, P  = 0.12).…”

“…Using the fixed-effects model, the meta-analysis of studies (OR 0.40; 95% CI 0.25 to 0.65; P  < 0.001; I 2  = 22%, P heterogeneity =0.28; Figure 3) [12,16,21,22] with a long-term (lasting for 48 h-72 h after operation) was similar to the overall effects (OR 0.56, 95% CI 0.40 to 0.77). However, it failed to reduce the incidence of POAF with a short-term NAC (within 24 h after surgery) supplementation (OR 0.64; 95% CI 0.39 to 1.06; P  = 0.09; I 2  = 0%, P heterogeneity =0.7; Figure 4) [19,23-26]. …”

“…Five studies [16,20,23,25,26] reported the data of ICU length of stay, while only three [16,20,26] studies reported the values as mean ± standard deviation. All the data were converted from days into hours for analysis.…”