Intratracheal N‐acetylcysteine use in infants with chronic lung disease

Abstract

To evaluate the effect of intratracheal administration of N-acetylcysteine (Mucomyst) on the clinical status, pulmonary function and gas exchange in premature infants with chronic lung disease, we conducted a randomized, placebo-controlled, crossover trial. Ten mechanically ventilated infants (gestational age 27 +/- 1 week; postnatal age 22 +/- 6 days) with clinical and radiological evidence of chronic lung disease and increased airway secretion were enrolled in the study. Each infant received tracheal administration of 5% N-acetylcysteine for one week and saline placebo every 4 h for another week. N-acetylcysteine was associated with a 59 +/- 26% increase in total airway resistance by the third day of treatment (p less than 0.01). A two-fold increase in airway resistance associated with an increased frequency of bradycardia and cyanosis spells was seen in two of the infants following three days of N-acetylcysteine administration, with a rapid improvement in their condition when subsequently switched to saline. Overall, N-acetylcysteine administration had no effect on the variables measured. We conclude that intratracheal administration of N-acetylcysteine to liquefy airway mucus neither improves the clinical condition nor hastens recovery in premature infants with chronic lung disease and its administration may lead to increased total airway resistance and cyanotic spells. The present data do not support the use of N-acetylcysteine as a mucolytic agent in premature infants with chronic lung disease.

The roles of drug therapy given via the endotracheal tube to neonates

“…In a randomised, placebo, cross-over trial of intratracheal N-acetylcysteine, 2 of the 10 premature infants with BPD had increased airway resistance and frequency of cyanotic spells and bradycardia when given N-acetylcysteine 48. The current data do not support the use of mucolytic agents in intubated infants.…”

Inhaled Birch Pollen Extract Induces Airway Hyperresponsiveness via Oxidative Stress but Independently of Pollen-Intrinsic NADPH Oxidase Activity, or the TLR4–TRIF Pathway

“…We also observed that intratracheal administration of NAC together with BPEx, unexpectedly, was toxic or pro-inflammatory to the animals. Delivery of NAC into the airways has been reported to have the potential to induce bronchospasm and irritant effects (43,44) and i.p. administration is far more common.…”

Dornase Alfa in Premature Infants With Severe Respiratory Distress and Early Bronchopulmonary Dysplasia

“…Likewise, N-acetylcysteine delivered intratracheally to 10 mechanically ventilated infants (gestational age=271 week; postnatal age=226 days) with BPD, led to an increase in airway resistance and the number of cyanotic spells without an appreciable effect on mucous viscosity. 19 In contrast, the combination of bronchoscopy plus N-acetylcysteine in a patient with severe asthma resulted in effective airway clearance and reduced airflow obstruction. 20 Both N-acetylcysteine and 2-mercaptoethane sulfonic acid work by breaking covalent bonds of the mucous through opening the disulfide connections.…”