Safety and efficacy of N-acetyl-cysteine for prophylaxis of ventilator-associated pneumonia: a randomized, double blind, placebo-controlled clinical trial.
Med Gas Res. 2018 Jan-Mar;8(1):19-23. Epub 2018 Apr 18. PMID: 29770192
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 (= 30) and control group (= 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%. 46.6%;= 0.032). Patients treated with NAC had significantly less ICU length of stay (14.36± 4.69 days. 17.81± 6.37 days,= 0.028) and less hospital stay (19.23± 5.54 days. 24.61± 6.81 days;= 0.03) than patients treated with placebo. Time to VAP was significantly longer in the NAC group (9.42± 1.9 days. 6.46± 2.53 days;= 0.002). The incidence of complete recovery was significantly higher in the NAC group (56.6%. 30%;= 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.