0
Articles |

Does N-Acetyl-L-Cysteine Influence Cytokine Response During Early Human Septic Shock?

Herbert Spapen; Haibo Zhang; Christian Demanet; Wim Vleminckx; Jean-Louis Vincent; Luc Huyghens
Author and Funding Information

Affiliations: From the Department of Intensive Care, Erasme University Hospital, Université Libre de Rruxelles, Brussels, Belgium,  From the Academic Hospital, Vrije Universiteit, and the Department of Intensive Care, Erasme University Hospital, Université Libre de Rruxelles, Brussels, Belgium,  From the Department of Hematology and Immunology, Erasme University Hospital, Université Libre de Rruxelles, Brussels, Belgium

Affiliations: From the Department of Intensive Care, Erasme University Hospital, Université Libre de Rruxelles, Brussels, Belgium,  From the Academic Hospital, Vrije Universiteit, and the Department of Intensive Care, Erasme University Hospital, Université Libre de Rruxelles, Brussels, Belgium,  From the Department of Hematology and Immunology, Erasme University Hospital, Université Libre de Rruxelles, Brussels, Belgium

Affiliations: From the Department of Intensive Care, Erasme University Hospital, Université Libre de Rruxelles, Brussels, Belgium,  From the Academic Hospital, Vrije Universiteit, and the Department of Intensive Care, Erasme University Hospital, Université Libre de Rruxelles, Brussels, Belgium,  From the Department of Hematology and Immunology, Erasme University Hospital, Université Libre de Rruxelles, Brussels, Belgium


1998 by the American College of Chest Physicians


Chest. 1998;113(6):1616-1624. doi:10.1378/chest.113.6.1616
Text Size: A A A
Published online

Abstract

Study objective: To assess the effects of adjunctive treatment with N-acetyl-L-cysteine (NAC) on hemodynamics, oxygen transport variables, and plasma levels of cytokines in patients with septic shock.

Design: Prospective, randomized, double-blind, placebo-controlled study.

Setting: A 24-bed medicosurgical ICU in a university hospital.

Patients: Twenty-two patients included within 4 h of diagnosis of septic shock.

Interventions: Patients were randomly allocated to receive either NAC (150 mg/kg bolus, followed by a continuous infusion of 50 mg/kg over 4 h; n=12) or placebo (n=10) in addition to standard therapy.

Measurements: Plasma concentrations of tumor necrosis factor-α (TNF), interleukin (IL)-6, IL-8, IL-10, and soluble tumor necrosis factor-α receptor-p55 (sTNFR-p55) were measured by sensitive immunoassays at 0, 2, 4, 6 and 24 h. Pulmonary artery catheter-derived hemodynamics, blood gases, hemoglobin, and arterial lactate were measured at baseline, after infusion (4 h), and at 24 h.

Results: NAC improved oxygenation (PaO2/FIO2 ratio, 214±97 vs 123±86; p<0.05) and static lung compliance (44±11 vs 31±6 L/cm H2O; p<0.05) at 24 h. NAC had no significant effects on plasma TNF, IL-6, or IL-10 levels, but acutely decreased IL-8 and sTNFR-p55 levels. The administration of NAC had no significant effect on systemic and pulmonary hemodynamics, oxygen delivery, and oxygen consumption. Mortality was similar in both groups (control, 40%; NAC, 42%) but survivors who received NAC had shorter ventilator requirement (7±2 days vs 20±7 days; p<0.05) and were discharged earlier from the ICU (13±2 days vs 32±9 days; p<0.05).

Conclusion: In this small cohort of patients with early septic shock, short-term IV infusion of NAC was well-tolerated, improved respiratory function, and shortened ICU stay in survivors. The attenuated production of IL-8, a potential mediator of septic lung injury, may have contributed to the lung-protective effects of NAC.


Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543