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Safety and Efficacy of N-Acetylcysteine as an Adjuvant Therapy in Critically Ill COVID-19 Patients

Abdelmonem et al., QJM: An International Journal of Medicine, doi:10.1093/qjmed/hcae070.076
Jun 2024  
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14th treatment shown to reduce risk in February 2021
*, now with p = 0.000027 from 24 studies, recognized in 3 countries.
Lower risk for mortality, hospitalization, and cases.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,400+ studies for 79 treatments.
Retrospective 80 ICU patients reporting no statistically significant differences with NAC treatment, however the actual results are not provided. The study is described as a retrospective observational study however authors also state that "patients were randomized into two equal groups". The "Non NAC" group also received NAC - the study compares high dose treatment over 21 hours versus low dose ongoing treatment.
Abdelmonem et al., 1 Jun 2024, retrospective, peer-reviewed, 4 authors, study period December 2020 - February 2022.
This PaperN-acetylcys..All
{ 'indexed': {'date-parts': [[2024, 7, 4]], 'date-time': '2024-07-04T00:23:57Z', 'timestamp': 1720052637169}, 'reference-count': 0, 'publisher': 'Oxford University Press (OUP)', 'issue': 'Supplement_1', 'license': [ { 'start': { 'date-parts': [[2024, 6, 1]], 'date-time': '2024-06-01T00:00:00Z', 'timestamp': 1717200000000}, 'content-version': 'vor', 'delay-in-days': 0, 'URL': ''}], 'content-domain': {'domain': [], 'crossmark-restriction': False}, 'published-print': {'date-parts': [[2024, 7, 3]]}, 'abstract': '<jats:title>Abstract</jats:title>\n' ' <jats:sec>\n' ' <jats:title>Background</jats:title>\n' ' <jats:p>COVID-19 may cause pneumonia, acute respiratory distress syndrome, ' 'cardiovascular alterations, and multiple organ failure, which have been ascribed to a ' 'cytokinestorm, a systemic inflammatory response, and an attack by the immune system. ' 'Moreover, an oxidative stress imbalance has been demonstrated to occur in COVID- 19 patients. ' 'N- Acetyl-L-cysteine (NAC) is a precursor of reduced glutathione (GSH).</jats:p>\n' ' </jats:sec>\n' ' <jats:sec>\n' ' <jats:title>Aim of the Work</jats:title>\n' ' <jats:p>we retrospectively will investigate safety and efficacy of NAC dose ' 'given in paracetamol toxicity as an adjuvant therapy in critically ill COVID-19 patients with ' 'acute respiratory distress and determine whether NAC in high doses can avoid respiratory ' 'failure in patients with COVID-19.</jats:p>\n' ' </jats:sec>\n' ' <jats:sec>\n' ' <jats:title>Patients and Methods</jats:title>\n' ' <jats:p>This was a retrospective observational study in which all cases ' 'were collected from ICU of Ain shams university hospitals during COVID-19 outbreak. All data ' 'were extracted from clinical records. All patients initially admitted to ICU with SPO2 less ' 'than 94 % were included between December 2020 to February 2022. Exclusion Criteria included ' 'Need for immediate mechanical ventilation on admission, known allergy or hypersensitivity to ' 'NAC, end stage renal and liver diseases, heart failure and pregnancy. All patients with ' 'severe COVID-19 (confirmed or suspected received standard care, according to the ' 'institutional protocol.</jats:p>\n' ' </jats:sec>\n' ' <jats:sec>\n' ' <jats:title>Results</jats:title>\n' ' <jats:p>Patients were randomized into two equal groups (number (n)=40 each) ' 'as the N1(NAC) group who was given intravenously, initially 150\u2009mg/kg in 200\u2009mL of ' '0.9% NaCL for 60\u2009minutes (first bag), followed by 50\u2009mg/kg in 500\u2009mL of 0.9% ' 'NaCL for 4\u2009hours (second bag), and then 100\u2009mg/kg in 1000\u2009mL of 0.9%NaCL for ' '16\u2009hours (third bag) and N2(Non NAC) group who received intravenously N-acetylcysteine ' '(NAC) 600mg /12hr and The primary endpoint was the need for mechanical ventilation. Secondary ' 'endpoints were time of mechanical ventilation, admission to the intensive care unit (ICU), ' 'time in ICU, and mortality. There were no statistically significant differences between the ' 'two groups (p\u2009&amp;gt;\u20090.05) The effect of NAC on mechanical ventilations, ' 'mortality, ICU stays, and hospital stays is a matter of controverse in ARDS patients. We ' 'found that intravenous high dose of NAC did not improve oxygenation, mortality rate and did ' 'not reduce the requirement for mechanical ventilation when administered for COVID 19 patients ' 'with ARDS. Also, the duration of ICU and hospital stays were relatively prolonged in the ' 'NAC-treated patients. These might be due to prolonged survival time with NAC-treated ' 'patients, but not to be detected with the small single centered trial..</jats:p>\n' ' </jats:sec>\n' ' <jats:sec>\n' ' <jats:title>Conclusion</jats:title>\n' ' <jats:p>Use of high doses of NAC administration can not affect the need of ' 'mechanical ventilation, rate of mortality, the need, duration of ICU admission and hospital ' 'stays for patients with severe COVID-19.</jats:p>\n' ' </jats:sec>', 'DOI': '10.1093/qjmed/hcae070.076', 'type': 'journal-article', 'created': {'date-parts': [[2024, 7, 3]], 'date-time': '2024-07-03T15:11:22Z', 'timestamp': 1720019482000}, 'source': 'Crossref', 'is-referenced-by-count': 0, 'title': 'Safety and Efficacy of N-Acetylcysteine as an Adjuvant Therapy in Critically Ill COVID-19 ' 'Patients', 'prefix': '10.1093', 'volume': '117', 'author': [ { 'given': 'Hany Saeed', 'family': 'Abdelmonem', 'sequence': 'first', 'affiliation': [ { 'name': 'Intensive Care Department, Faculty of Medicine, Ain Shams ' 'University'}]}, { 'given': 'Hanaa Mohamed Abd', 'family': 'Allah Elgendy', 'sequence': 'additional', 'affiliation': [ { 'name': 'Intensive Care Department, Faculty of Medicine, Ain Shams ' 'University'}]}, { 'given': 'Doaa Mohammed', 'family': 'Kamal El-Din', 'sequence': 'additional', 'affiliation': [ { 'name': 'Intensive Care Department, Faculty of Medicine, Ain Shams ' 'University'}]}, { 'given': 'Eman Mohamed', 'family': 'Elshaer', 'sequence': 'additional', 'affiliation': [ { 'name': 'Intensive Care Department, Faculty of Medicine, Ain Shams ' 'University'}]}], 'member': '286', 'published-online': {'date-parts': [[2024, 7, 3]]}, 'container-title': 'QJM: An International Journal of Medicine', 'original-title': [], 'language': 'en', 'link': [ { 'URL': '', 'content-type': 'application/pdf', 'content-version': 'vor', 'intended-application': 'syndication'}, { 'URL': '', 'content-type': 'unspecified', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2024, 7, 3]], 'date-time': '2024-07-03T15:11:27Z', 'timestamp': 1720019487000}, 'score': 1, 'resource': { 'primary': { 'URL': ''}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2024, 6, 1]]}, 'references-count': 0, 'journal-issue': { 'issue': 'Supplement_1', 'published-online': {'date-parts': [[2024, 7, 3]]}, 'published-print': {'date-parts': [[2024, 7, 3]]}}, 'URL': '', 'relation': {}, 'ISSN': ['1460-2725', '1460-2393'], 'subject': [], 'published-other': {'date-parts': [[2024, 6, 1]]}, 'published': {'date-parts': [[2024, 6, 1]]}}
Late treatment
is less effective
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