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A Trial of Antioxidants N-acetylcysteine and Procysteine in ARDS FREE TO VIEW

Gordon R. Bernard; Arthur P. Wheeler; Murray M. Arons; Peter E. Morris; Harold L. Paz; James A. Russell; Patrick E. Wright; The Antioxidant in ARDS Study Group
Author and Funding Information

From the Center for Lung Research, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tenn.

From the Center for Lung Research, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tenn.


From the Center for Lung Research, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tenn.

1997 by the American College of Chest Physicians


Chest. 1997;112(1):164-172. doi:10.1378/chest.112.1.164
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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 ARDS 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.


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