The immunological benefit of higher dose N-acetyl cysteine following mechanical ventilation in critically ill patients
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RESEARCH ARTICLE
Open Access
The immunological benefit of higher dose N-acetyl cysteine following mechanical ventilation in critically ill patients Atabak Najafi1, Mojtaba Mojtahedzadeh1,2,3, Keyvan Haji Ahmadi2, Mohammad Abdollahi3, Maryam Mousavi4, Legese Chelkeba2,3, Farhad Najmeddin2 and Arezoo Ahmadi1*
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). Conclusion: 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. Keywords: N-Acetyl, Cysteine (NAC), Glutathione (GSH), Human β Defensin 2 (HβD2), Immunoglobulin M (IgM), Multiple trauma, Sepsis
Background Multiple trauma, a complex syndrome of injuries to various anatomical regions with defined intensity and subsequent systemic reactions [1]. Trauma is the major cause of death before the age of 45 in developed countries [2,3], claiming over 6 million kills annually around the * Correspondence: [email protected] 1 Department of Anesthesiology and Critical Care Medicine, Sina Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran Full list of author information is available at the end of the article
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