A trial of antioxidants N-acetylcysteine and procysteine in ARDS

Gordon R. Bernard, Arthur P. Wheeler, Murray M. Arons, Peter E. Morris, Harold L. Paz, James A. Russell, Patrick E. Wright

Research output: Contribution to journalArticlepeer-review

383 Scopus citations

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 AIDS and IV 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.

Original languageEnglish
Pages (from-to)164-172
Number of pages9
JournalChest
Volume112
Issue number1
DOIs
StatePublished - 1997

Keywords

  • ARDS
  • Antioxidants
  • Cysteine
  • Glutathione
  • Lung injury
  • N- acetylcysteine
  • Oxothiazolidine-carboxylate
  • Procysteine

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

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