n-monoacetylcystine and Critical-Illness

This study reviews important nutrients responsible for oxidant-antioxidant balance in trauma patients requiring admission to the ICU and rationale for repletion of antioxidants using pharmaconutrition.. Oxidative stress is an underlying cause of critical illness due to oxidant-antioxidant imbalance. Multiple nutrients important to oxidative balance have been studied, yet much variety exists among the dosing, timing, and route of administration. Conflict also exists regarding the benefits of particular single nutrients and the effects of combination therapy. Anticipated results of the Reducing Deaths due to Oxidative Stress trial hope to provide further insight to the use of antioxidants in critically ill patients.. The goal of this review, though not exhaustive, serves to highlight recent significant studies regarding antioxidant use in the ICU setting while calling for sufficiently powered randomized, controlled trials to elucidate appropriate guidelines for antioxidant administration in regards to ideal dosing, route of administration, timing of administration, duration of therapy, and the role of single versus combination supplementation.

Topics: Antioxidants; Arginine; Ascorbic Acid; Critical Illness; Cystine; Dietary Supplements; Fatty Acids; Glutamine; Humans; Intensive Care Units; Micronutrients; Oxidative Stress; Selenium; Zinc

Many patients each year require prolonged mechanical ventilation. Inflammatory processes may prevent successful weaning, and evidence indicates that mechanical ventilation induces oxidative stress in the diaphragm, resulting in atrophy and contractile dysfunction of diaphragmatic myofibers. Antioxidant supplementation might mitigate the harmful effects of the oxidative stress induced by mechanical ventilation.. To test the clinical effectiveness of antioxidant supplementation in reducing the duration of mechanical ventilation.. A randomized, prospective, placebo-controlled double-blind design was used to test whether enterally administered antioxidant supplementation would decrease the duration of mechanical ventilation, all-cause mortality, and length of stay in the intensive care unit and hospital. Patients received vitamin C 1000 mg plus vitamin E 1000 IU, vitamin C 1000 mg plus vitamin E 1000 IU plus N-acetylcysteine 400 mg, or placebo solution as a bolus injection via their enteral feeding tube every 8 hours.. Clinical and statistically significant differences in duration of mechanical ventilation were seen among the 3 groups (Mantel-Cox log rank statistic = 5.69, df = 1, P = .017). The 3 groups did not differ significantly in all-cause mortality during hospitalization or in the length of stay in the intensive care unit or hospital.. Enteral administration of antioxidants is a simple, safe, inexpensive, and effective intervention that decreases the duration of mechanical ventilation in critically ill adults.

Topics: Adult; Aged; Aged, 80 and over; Antioxidants; Ascorbic Acid; Critical Care; Critical Illness; Cystine; Double-Blind Method; Female; Humans; Inflammation; Length of Stay; Male; Middle Aged; Oxidative Stress; Prospective Studies; Respiration, Artificial; Time Factors; Treatment Outcome; Vitamin E; Vitamins