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RESEARCH ARTICLE
Year : 2018  |  Volume : 8  |  Issue : 1  |  Page : 19-23

Safety and efficacy of N-acetyl-cysteine for prophylaxis of ventilator-associated pneumonia: A randomized, double blind, placebo-controlled clinical trial


1 General Practitioner, School of Medicine, Arak University of Medical Sciences, Arak, Iran
2 Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
3 Department of Infectious Disease, School of Medicine, Arak University of Medical Sciences, Arak; Neurology and Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran
4 Neurology and Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran
5 Department of Psychiatry, School of Medicine, Hormozgan University of Medical Sciences, Hormozgan, Iran
6 Students Research Committee, Arak University of Medical Sciences, Arak, Iran

Correspondence Address:
Ali Abdolrazaghnejad
Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran
Iran
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Source of Support: This study was financially supported by Arak University of Medical Sciences, Iran., Conflict of Interest: None


DOI: 10.4103/2045-9912.229599

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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.


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