N-Acetylcysteine pretreatment of cardiac surgery patients influences plasma neutrophil elastase and neutrophil influx in bronchoalveolar lavage fluid

Backer, Wilfried A. De; Amsel, Bram J.; Jorens, P. G.; Bossaert, Leo; Hiemstra, Pieter S.; Noort, Peter van; Overveld, F. J. van

doi:10.1007/s001340050185

Cited by 11 publications

(14 citation statements)

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“…Therefore, we designed our study to assess the effects of N-acetylcysteine treatment given before and during surgery on early postoperative organ dysfunction. Nevertheless, we were unable to show improved respiratory, cardiac or other organ function despite encouraging results obtained by others 29 . This discrepancy could be explained by the different patient population.…”

Section: Discussioncontrasting

confidence: 73%

Lack of Effect of Prophylactic N-acetylcysteine on Postoperative Organ Dysfunction following Major Abdominal Tumour Surgery: A Randomized, Placebo-controlled, Double-blinded Clinical Trial

Szakmány

Márton

Molnár

2003

Anaesth Intensive Care

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Sepsis and respiratory dysfunction leading to multiple system organ failure remains the leading cause of postoperative morbidity and mortality following major surgical procedures. It has been suggested the oxygen free radicals might play a pivotal role in this process. The aim of this study was to investigate whether short-term infusion of N-acetylcysteine (N-acetylcysteine), a potent antioxidant, administered before and during extensive abdominal surgery, could ameliorate the progression of early postoperative organ dysfunction and improve oxygenation. Out of the 93 patients, 47 received N-acetylcysteine and 46 were given placebo in a randomized, controlled, double-blinded fashion. Patients received N-acetylcysteine (150 mg.kg-1 bolus followed by a continuous infusion of 12 mg.kg-1 .h-1) or the same volume of placebo (5% dextrose) during surgery. Treatment effect on organ function was assessed by organ dysfunction scores according to physiological parameters of six main organ systems: respiratory, cardiovascular, renal, hepatic, haematological and central nervous system. The scores were obtained on admission, then daily during the first three postoperative days. For statistical analysis Mann-Whitney U and Chi-squared tests were used. There was no significant difference between the two groups in any of the six organ dysfunction parameters, length of intensive care stay, days of mechanical ventilation and mortality. Our results do not support the routine use of N-acetylcysteine as a prophylactic measure during surgery, and reinforce previous evidence which challenges the indication of N-acetylcysteine in the critically ill.

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Section: Discussioncontrasting

confidence: 73%

Lack of Effect of Prophylactic N-acetylcysteine on Postoperative Organ Dysfunction following Major Abdominal Tumour Surgery: A Randomized, Placebo-controlled, Double-blinded Clinical Trial

Szakmány

Márton

Molnár

2003

Anaesth Intensive Care

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“…Among the 29 eligible RCTs, trials took place in a variety of settings (S5 Table) including Turkey [20, 53, 54, 59, 60, 63, 66, 67, 69, 70], Canada [56, 58, 79], United States of America [52, 55], Finland [73, 78], Germany [61], Italy [75], Belgium [57], India [68, 71, 72], South Korea [65, 77], Iran [64, 76], Brazil [74] and Australia [62]. Sample sizes ranged from 18 [57] to 295 [56] participants (S5 Table).…”

Section: Resultsmentioning

confidence: 99%

N-acetylcysteine use among patients undergoing cardiac surgery: A systematic review and meta-analysis of randomized trials

et al. 2019

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Background Cardiac surgeries are complex procedures aiming to re-establish coronary flow and correct valvular defects. Oxidative stress, caused by inflammation and ischemia-reperfusion injury, is associated with these procedures, increasing the risk of adverse outcomes. N-acetylcysteine (NAC) acts as an antioxidant by replenishing the glutathione stores, and emerging evidence suggests that NAC may reduce the risk of adverse perioperative outcomes. We conducted a systematic review and meta-analysis to investigate the addition of NAC to a standard of care among adult patients undergoing cardiac surgery. Methods We searched four databases (PubMed, EMBASE, CENTRAL, LILACS) from inception to October 2018 and the grey literaure for randomized controlled trials (RCTs) investigating the effect of NAC on pre-defined outcomes including mortality, acute renal insufficiency (ARI), acute cardiac insufficiency (ACI), hospital length of stay (HLoS), intensive care unit length of stay (ICULoS), arrhythmia and acute myocardial infarction (AMI). Reviewers independently screened potentially eligible articles, extracted data and assessed the risk of bias among eligible articles. We used the GRADE approach to rate the overall certainty of evidence for each outcome. Results Twenty-nine RCTs including 2,486 participants proved eligible. Low to moderate certainty evidence demonstrated that the addition of NAC resulted in a non-statistically significant reduction in mortality (Risk Ratio (RR) 0.71; 95% Confidence Interval (CI) 0.40 to 1.25), ARI (RR 0.92; 95% CI 0.79 to 1.09), ACI (RR 0.77; 95% CI 0.44 to 1.38), HLoS (Mean Difference (MD) 0.21; 95% CI -0.64 to 0.23), ICULoS (MD -0.04; 95% CI -0.29 to 0.20), arrhythmia (RR 0.79; 95% CI 0.52 to 1.20), and AMI (RR 0.84; 95% CI 0.48 to 1.48). Limitations Among eligible trials, we observed heterogeneity in the population and interventions including patients with and without kidney dysfunction and interventions that differed in route of administration, dosage, and duration of treatment. This observed heterogeneity was not explained by our subgroup analyses. Conclusions The addition of NAC during cardiac surgery did not result in a statistically significant reduction in clinical outcomes. A large randomized placebo-controlled multi-centre trial is needed to determine whether NAC reduces mortality. Registration PROSPERO CRD42018091191.

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“…4 NAC also prevents the migration of neutrophils to the inflamed regions. 18 It has been observed that NAC reduces the accumulation of the inflammatory cells and the inflammatory cytokine production. Thereby, inflammation regresses.…”

Section: Discussionmentioning

confidence: 99%

Potential Benefits of Combined N‐Acetylcysteine and Ciprofloxacin Therapy in Partial Biliary Obstruction

Özdil

Keçe²,

Coşar³

et al. 2010

The Journal of Clinical Pharma

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This study investigates the potential benefits of antibiotics and N-acetylcysteine (NAC), a mucolytic agent, in patients who are candidates for endoscopic retrograde cholangiopancreatography (ERCP) due to partial bile duct obstruction. In total, 102 patients who had choledocholithiasis and choledochal dilatations by abdominal ultrasonography were included in the study. The patients were divided into placebo and NAC therapy groups. Physiological saline (equal volume with NAC solution) and ciprofloxacin (2 × 200 mg/d intravenously) were administered to the placebo group, and NAC (1800 mg/d intravenously) and ciprofloxacin (2 × 200 mg/d intravenously) were administered to the NAC group. In both groups, treatment protocols were administered for 7 days before ERCP. Total and direct bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), C-reactive protein (CRP), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT), white blood cell (WBC) count, and neutrophil percent (NE%) levels were measured before the 7-day treatment protocol. The same measurements were also evaluated before ERCP. In the NAC group, the levels of ALP, GGT, WBC, CRP, and NE% decreased significantly (P < .001), whereas a significant decrease did not occur in the placebo group. The combined usage of NAC and ciprofloxacin can be an alternative therapeutic option until ERCP is performed in partial cholestatic patients.

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N-Acetylcysteine pretreatment of cardiac surgery patients influences plasma neutrophil elastase and neutrophil influx in bronchoalveolar lavage fluid

Abstract: Pretreatment with NAC may prevent lung injury by diminishing elastase activity. Since the release of mediators, especially MPO, is not affected, this diminished activity of elastase may be achieved by enhanced inactivation by antiproteases after initial treatment.

Cited by 11 publications

References 0 publications

Lack of Effect of Prophylactic N-acetylcysteine on Postoperative Organ Dysfunction following Major Abdominal Tumour Surgery: A Randomized, Placebo-controlled, Double-blinded Clinical Trial

Lack of Effect of Prophylactic N-acetylcysteine on Postoperative Organ Dysfunction following Major Abdominal Tumour Surgery: A Randomized, Placebo-controlled, Double-blinded Clinical Trial

N-acetylcysteine use among patients undergoing cardiac surgery: A systematic review and meta-analysis of randomized trials

Potential Benefits of Combined N‐Acetylcysteine and Ciprofloxacin Therapy in Partial Biliary Obstruction

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