Safety and efficacy of N-acetyl-cysteine for prophylaxis of ventilator-associated pneumonia: A randomized, double blind, placebo-controlled clinical trial

Abstract

Ventilator-associated-pneumonia (VAP) is characterized by morbidity, mortality, and prolonged length of stay in intensive care unit (ICU). The present study aimed to examine the effect of N-acetyl-cysteine (NAC) in preventing VAP in patients hospitalized in ICU. We performed a prospective, randomized, double-blind, placebo-controlled trial of 60 mechanically ventilated patients at high risk of developing VAP. NAC (600 mg/twice daily) and placebo (twice daily) were administered to NAC group (n = 30) and control group (n = 30), respectively, through the nasogastric tube in addition to routine care. The clinical response was considered as primary (incidence of VAP) and secondary outcomes. Twenty-two (36.6%) patients developed VAP. Patients treated with NAC were significantly less likely to develop clinically confirmed VAP compared with patients treated with placebo (26.6% vs. 46.6%; P = 0.032). Patients treated with NAC had significantly less ICU length of stay (14.36 ± 4.69 days vs. 17.81 ± 6.37 days, P = 0.028) and less hospital stay (19.23 ± 5.54 days vs. 24.61 ± 6.81 days; P = 0.03) than patients treated with placebo. Time to VAP was significantly longer in the NAC group (9.42 ± 1.9 days vs. 6.46 ± 2.53 days; P = 0.002). The incidence of complete recovery was significantly higher in the NAC group (56.6% vs. 30%; P = 0.006). No adverse events related to NAC were identified. NAC is safe and effective to prevent and delay VAP, and improve its complete recovery rate in a selected, high-risk ICU population.

Antioxidants and pentoxifylline as coadjuvant measures to standard therapy to improve prognosis of patients with pneumonia by COVID-19

“…NAC reduces the incidence of pneumonia, as well as the frequency and severity of influenza [67] . It also reduces levels of TNF-α and malondialdehyde and improves OS and modulates inflammation [68] .…”

Drug Prevention and Control of Ventilator-Associated Pneumonia

“…For prevention, a VAP care bundle, nursing care and education are recommended; these strategies have been shown to decrease the health care costs and antimicrobials use, length of ICU stay, and the need of mechanical ventilation therapy (Aiken et al, 2014; Okgun Alcan et al, 2016; Nogueira et al, 2017; Jansson et al, 2019). In addition, a recent study has suggested that N -acetyl-cysteine (NAC) is safe and effective to prevent and delay the development of VAP (Sharafkhah and Abdolrazaghnejad, 2018). It’s also very important to use new diagnostic methods (such as next-generation sequencing technology, phase contrast X-ray imaging, lung ultrasonography (Bouhemad et al, 2018), and the electronic nose) and/or new biomarkers (such as phosphatidylinositol 3-kinase regulatory subunit and sarcoplasmic reticulum calcium transporting ATPase) (Jamaati et al, 2018), to find the bacteriology and its frequency of MDR pathogens and to guide more accurate and focused initial antibiotic therapy.…”

N-Acetylcysteine as Adjuvant Therapy for COVID-19 – A Perspective on the Current State of the Evidence

“…67 Benefits were also documented in patients diagnosed with community acquired pneumonia whose plasma levels of malondialdehyde (oxidative stress parameter) and TNF-α (inflammatory mediator) were decreased and total antioxidant capacity was increased significantly among those treated with N-acetylcysteine. 68 Moreover, N-acetylcysteine resulted in a lower rate of ventilatorassociated-pneumonia compared with placebo. Patients treated with N-acetylcysteine had significantly shorter length of stay in the ICU, reduced time to hospital discharge, and a higher rate of complete recovery.…”

“…Patients treated with N-acetylcysteine had significantly shorter length of stay in the ICU, reduced time to hospital discharge, and a higher rate of complete recovery. 69 A clinical case study revealed that combination therapy of oseltamivir and N-acetylcysteine improved clinical outcomes in a woman with H1N1 influenza pneumonia, with clearance of pulmonary infiltrates, decreased requirement for oxygen supplementation, and lower plasma level of C-reactive protein. 70 …”