Influence of N-acetylcysteine on indirect indicators of tissue oxygenation in septic shock patients: Results from a prospective, randomized, double-blind study

The effect of N-acetylcysteine on total serum anti-oxidant potential and urinary albumin excretion in critically ill patients

“…Similar protection to endogenous mechanisms against free radical mediated injury might be achieved with exogenous agents such as N-acetylcysteine (NAC), which has been in clinical practice for 40 years, historically for cystic fibrosis and chronic bronchitis and later for paracetamol overdose. Based on the encouraging results of benefit in clinical studies of patients with adult respiratory distress syndrome (ARDS) and sepsis [10][11][12], where NAC was used as a free radical scavenger, we decided to investigate the early use of NAC in a heterogeneous critically ill population.…”

Prophylactic N-acetylcysteine decreases serum CRP but not PCT levels and microalbuminuria following major abdominal surgery. A prospective, randomised, double-blinded, placebo-controlled clinical trial

“…4). Significantly lower serum CRP levels were observed in the NAC group at t 24 Preoperative M:Cr values were within the normal range. There was a significant increase in M:Cr on admission to the ICU (t 0 ), but levels returned to normal within 6 h and remained so for the rest of the study.…”

“…The boxes enclose the interquartile range and median (middle line in each box); the whiskers enclose the minimum and maximum. Differences between the two groups at each assessment point were tested using the Mann-Whitney U-test matory process might improve outcome [23,24]. Unfortunately, real pre-treatment of septic patients cannot be achieved in clinical practice.…”

“…N-acetylcysteine has important antioxidant properties, decreases neutrophil-aggregating activity and enhances nitric oxide release by the endothelium [13,14,15]. Despite the theoretical advantages, the benefit of NAC to critically ill patients remains controversial [23,24,28,29,30]. However, encouraging results have also been published.…”

“…One of the reasons could be that PCT release might be linked to pathways taking place in other organs than the liver and not directly influenced by OFR production. Another likely possibility is that NAC is unable to interfere with the pathophysiological events following surgery, as indicated by several clinical trials with negative results [23,24,28,39].…”