A trial of antioxidants N-acetylcysteine and procysteine in ARDS. The Antioxidant in ARDS Study Group.

Academic Article

Abstract

  • OBJECTIVE: To determine the levels of glutathione and cysteine in patients with ARDS and examine the effect of treatment with N-acetylcysteine (NAC) and L-2-oxothiazolidine-4-carboxylate (Procysteine; Clintec Technologies Inc; Chicago [OTZ]) on these levels and on common physiologic abnormalities, and organ dysfunction associated with ARDS. DESIGN: Randomized, double-blind, placebo-controlled, prospective clinical trial. SETTING: ICUs in five clinical centers in the United States and Canada. PATIENTS: Patients meeting a predetermined definition of ARDS and requiring mechanical ventilation. INTERVENTION: Standard care for ARDS and I.V. infusion, every 8 h for 10 days, of one of the following: NAC (70 mg/kg, n=14), OTZ (63 mg/kg, n=17), or placebo (n=15). MAIN RESULTS: Both antioxidants effectively repleted RBC glutathione gradually over the 10-day treatment period (47% and 49% increases from baseline values for NAC and OTZ, respectively). There was no difference in mortality among groups (placebo, 40%; NAC, 36%; OTZ, 35%). However, the number of days of acute lung injury was decreased and there was also a significant increase in cardiac index in both treatment groups (NAC/OTZ [+]14%; placebo [-]6%). CONCLUSIONS: Our findings suggest that repletion of glutathione may safely be accomplished with NAC or OTZ in patients with acute lung injury/ARDS. Such treatment may shorten the duration of acute lung injury, but larger studies are needed to confirm this.

    • Authors

    Published In

  • Chest  Journal

    • Keywords

  • Acetylcysteine, Adult, Antioxidants, Bilirubin, Bronchoalveolar Lavage Fluid, Cardiac Output, Cysteine, Double-Blind Method, Free Radical Scavengers, Glutathione, Humans, Middle Aged, Prospective Studies, Pyrrolidonecarboxylic Acid, Respiration, Artificial, Respiratory Distress Syndrome, Thiazoles, Thiazolidines, Time Factors

    • Digital Object Identifier (doi)

    Author List

  • Bernard GR; Wheeler AP; Arons MM; Morris PE; Paz HL; Russell JA; Wright PE

    • Start Page

  • 164

    • End Page

  • 172

    • Volume

  • 112

    • Issue

  • 1