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All Studies   Meta Analysis    Recent:   
0 0.5 1 1.5 2+ Mortality 10% Improvement Relative Risk N-acetylcysteine  Delić et al.  INTUBATED PATIENTS  RCT Is very late treatment with N-acetylcysteine beneficial for COVID-19? RCT 91 patients in Croatia (October 2020 - June 2021) No significant difference in mortality c19early.org Delić et al., Microorganisms, May 2022 Favors N-acetylcysteine Favors control

Effects of Different Inhalation Therapy on Ventilator-Associated Pneumonia in Ventilated COVID-19 Patients: A Randomized Controlled Trial

Delić et al., Microorganisms, doi:10.3390/microorganisms10061118, NCT04755972
May 2022  
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14th treatment shown to reduce risk in February 2021
 
*, now known with p = 0.000034 from 24 studies, recognized in 3 countries.
Lower risk for mortality, hospitalization, and cases.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
3,900+ studies for 60+ treatments. c19early.org
RCT mechanically ventilated patients in Croatia, 39 treated with N-acetylcysteine and 52 control patients, showing no significant difference in mortality with treatment. Treated patients showed a lower incidence of gram-positive or MRSA-caused ventilator-associated pneumonia.
Study covers alkalinization and N-acetylcysteine.
risk of death, 9.7% lower, RR 0.90, p = 0.67, treatment 21 of 39 (53.8%), control 31 of 52 (59.6%), NNT 17.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Delić et al., 28 May 2022, Randomized Controlled Trial, Croatia, peer-reviewed, 12 authors, study period October 2020 - June 2021, trial NCT04755972 (history). Contact: ndelic@kbsplit.hr (corresponding author), tkljakgas@kbsplit.hr, lsaric@kbsplit.hr, dilic@kbsplit.hr, sdosenovic@kbsplit.hr, jdomazet@kbsplit.hr, rkovac@kbsplit.hr, sastojanovic@kbsplit.hr, bduplanc@kbsplit.hr, andrija.matetic@gmail.com, frane.runjic@gmail.com, josipa.domjanovic@gmail.com.
This PaperN-acetylcys..All
Effects of Different Inhalation Therapy on Ventilator-Associated Pneumonia in Ventilated COVID-19 Patients: A Randomized Controlled Trial
Nikola Delić, Andrija Matetic, Josipa Domjanović, Toni Kljaković-Gašpić, Lenko Šarić, Darko Ilić, Svjetlana Došenović, Josipa Domazet, Ruben Kovač, Frane Runjić, Sanda Stojanović Stipić, Božidar Duplančić
Microorganisms, doi:10.3390/microorganisms10061118
The effect of routine inhalation therapy on ventilator-associated pneumonia (VAP) in mechanically ventilated patients with the coronavirus disease (COVID-19) has not been well-defined. This randomized controlled trial included 175 eligible adult patients with COVID-19 who were treated with mechanical ventilation at the University Hospital of Split between October 2020 and June 2021. Patients were randomized and allocated to a control group (no routine inhalation) or one of the treatment arms (inhalation of N-acetylcysteine; 5% saline solution; or 8.4% sodium bicarbonate). The primary outcome was the incidence of VAP, while secondary outcomes included all-cause mortality. Routine inhalation therapy had no effect on the incidence of bacterial or fungal VAP nor on all-cause mortality (p > 0.05). Secondary analyses revealed a significant reduction of Gram-positive and methicillin-resistant Staphylococcus aureus (MRSA) VAP in the treatment groups. Specifically, the bicarbonate group had a statistically significantly lower incidence of Gram-positive bacterial VAP (4.8%), followed by the N-acetylcysteine group (10.3%), 5% saline group (19.0%), and control group (34.6%; p = 0.001). This difference was driven by a lower incidence of MRSA VAP in the bicarbonate group (2.4%), followed by the N-acetylcysteine group (7.7%), 5% saline group (14.3%), and control group (34.6%; p < 0.001). Longer duration of ventilator therapy was the only significant, independent predictor of any bacterial or fungal VAP in the multivariate analysis (aOR 1.14, 95% CI 1.01-1.29, p = 0.038 and aOR 1.05, 95% CI 1.01-1.10, p = 0.028, respectively). In conclusion, inhalation therapy had no effect on the overall VAP incidence or all-cause mortality. Further studies should explore the secondary findings of this study such as the reduction of Gram-positive or MRSA-caused VAP in treated patients.
Conflicts of Interest: The authors declare no conflict of interest.
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Late treatment
is less effective
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