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

Bernard GR, Wheeler AP, Arons MM, Morris PE, Paz HL, Russell JA, Wright PE
Chest. 1997 112 (1): 164-72

PMID: 9228372 · DOI:10.1378/chest.112.1.164

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.

MeSH Terms (19)

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

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