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Safety and Efficacy of N-Acetyl-Cysteine for Prophylaxis of Ventilator-Associated Pneumonia: A Randomized, Double Blind, Placebo-Controlled Clinical Trial Publisher



Sharafkhah M1 ; Abdolrazaghnejad A2 ; Zarinfar N3, 4 ; Mohammadbeigi A4 ; Massoudifar A5 ; Abaszadeh S6
Authors
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Authors Affiliations
  1. 1. General Practitioner, School of Medicine, Arak University of Medical Sciences, Arak, Iran
  2. 2. Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Department of Infectious Disease, School of Medicine, Arak University of Medical Sciences, Arak, Iran
  4. 4. Neurology and Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran
  5. 5. Department of Psychiatry, School of Medicine, Hormozgan University of Medical Sciences, Hormozgan, Iran
  6. 6. Stud. Research Committee, Arak University of Medical Sciences, Arak, Iran

Source: Medical Gas Research Published:2018


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. © 2018 Medical Gas Research Published by Wolters Kluwer -Medknow.