Phase II, randomized, controlled trial of high-dose N-acetylcysteine in high-risk cardiac surgery patients.


OBJECTIVE:To assess the effect of high-dose N-acetylcysteine on renal function in cardiac surgery patients at higher risk of postoperative renal failure. DESIGN:Multiblind, placebo-controlled, randomized, phase II clinical trial. SETTING:Operating rooms and intensive care units of two tertiary referral hospitals. PATIENTS:A total of 60 cardiac surgery patients at higher risk of postoperative renal failure. INTERVENTIONS:Patients were allocated to either 24 hrs of high-dose N-acetylcysteine infusion (300 mg/kg body weight in 5% glucose, 1.7 L) or placebo (5% glucose, 1.7 L). MEASUREMENTS AND MAIN RESULTS:The primary outcome measure was the absolute change in serum creatinine from baseline to peak value within the first five postoperative days. Secondary outcomes included the relative change in serum creatinine, peak serum creatinine level, serum cystatin C, and in urinary output. Further outcomes were needed for renal replacement therapy, length of ventilation, and length of stay in the intensive care unit and hospital. Randomization was successful and patients were well balanced for preoperative and intraoperative characteristics. There was no significant attenuation in the increase in serum creatinine from baseline to peak when comparing N-acetylcysteine with placebo (64.5 +/- 91.2 and 38.0 +/- 42.4 mumol/L, respectively; p = .15). Also, there was no attenuation in the increase in serum cystatin C from baseline to peak for N-acetylcysteine compared with placebo (0.45 +/- 0.43 and 0.30 +/- 0.33 mg/L, respectively; p = .40). Likewise, there was no evidence for differences in any other clinical outcome. CONCLUSIONS:In this phase II, randomized, controlled trial, high-dose N-acetylcysteine was no more effective than placebo in attenuating cardiopulmonary bypass-related acute renal failure in high-risk cardiac surgery patients.


Crit Care Med


Critical care medicine


Haase M,Haase-Fielitz A,Bagshaw SM,Reade MC,Morgera S,Seevenayagam S,Matalanis G,Buxton B,Doolan L,Bellomo R




Has Abstract


2007-05-01 00:00:00












  • Early combination antibiotic therapy yields improved survival compared with monotherapy in septic shock: a propensity-matched analysis.

    abstract:BACKGROUND:Septic shock represents the major cause of infection-associated mortality in the intensive care unit. The possibility that combination antibiotic therapy of bacterial septic shock improves outcome is controversial. Current guidelines do not recommend combination therapy except for the express purpose of broa...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审


    authors: Kumar A,Zarychanski R,Light B,Parrillo J,Maki D,Simon D,Laporta D,Lapinsky S,Ellis P,Mirzanejad Y,Martinka G,Keenan S,Wood G,Arabi Y,Feinstein D,Kumar A,Dodek P,Kravetsky L,Doucette S,Cooperative Antimicrobial Thera

    更新日期:2010-09-01 00:00:00

  • Endothelial cell apoptosis in sepsis.

    abstract:OBJECTIVE:To discuss a potential role for endothelial cell apoptosis in the pathogenesis of sepsis. DATA SOURCES:Studies published in biomedical journals and studies from the authors' laboratory. STUDY SELECTION:In vitro and in vivo studies of endothelial cell apoptosis in endotoxin and sepsis models. DATA EXTRACTIO...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审


    authors: Hotchkiss RS,Tinsley KW,Swanson PE,Karl IE

    更新日期:2002-05-01 00:00:00

  • Factors related to quality of life 12 months after discharge from an intensive care unit.

    abstract:OBJECTIVE:To perform an analysis of the quality of life of survivors after ICU discharge. DESIGN:Prospective study. SETTING:Medical-surgical ICU of a Spanish reference hospital. PATIENTS:Patients (n = 606) admitted in a 6-month period. METHOD:A questionnaire regarding quality of life issues was completed at the tim...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Vazquez Mata G,Rivera Fernandez R,Gonzalez Carmona A,Delgado-Rodriguez M,Torres Ruiz JM,Raya Pugnaire A,Aguayo de Hoyos E

    更新日期:1992-09-01 00:00:00

  • Chlorpromazine treatment for neurogenic pulmonary edema.

    abstract::A patient with neurogenic pulmonary edema was successfully treated with the alpha-blocking agent, chlorpromazine. A pathophysiologic basis for this drug's efficacy is discussed. ...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Wohns RN,Tamas L,Pierce KR,Howe JF

    更新日期:1985-03-01 00:00:00

  • Steroid controversy in sepsis and septic shock: a meta-analysis.

    abstract:OBJECTIVE:The use of corticosteroids in patients with sepsis or septic shock has been controversial for many decades. Clinical studies have reported beneficial, as well as negative results. We conducted a meta-analysis to assess the clinical evidence and to evaluate treatment effects in specific subgroups of patients. ...

    journal_title:Critical care medicine

    pub_type: 杂志文章,meta分析


    authors: Lefering R,Neugebauer EA

    更新日期:1995-07-01 00:00:00

  • Allergic and hypersensitivity reactions in the intensive care unit.

    abstract::Hypersensitivity reactions are defined as immunologically based adverse reactions to chemicals or medicinal agents. These reactions are common in the intensive care unit and can present as a simple, mildly symptomatic rash or as life-threatening anaphylactic reactions. Hypersensitivity reactions have traditionally bee...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审


    authors: Kanji S,Chant C

    更新日期:2010-06-01 00:00:00

  • A method for predicting survival and mortality of ICU patients using objectively derived weights.

    abstract::Data at ICU admission and after 24 h in the ICU were collected on 755 patients, to derive multiple logistic regression models for predicting hospital mortality. The derived models contained relatively few and easily obtained variables. The weight associated with each variable was determined objectively. There were sev...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Lemeshow S,Teres D,Pastides H,Avrunin JS,Steingrub JS

    更新日期:1985-07-01 00:00:00

  • Opioid Use After Intensive Care: A Nationwide Cohort Study.

    abstract:OBJECTIVE:To describe opioid use after ICU admission, identify factors associated with chronic opioid use after critical care, and determine if chronic opioid use is associated with an increased risk of death. DESIGN:Retrospective cohort study. SETTING:Sweden including all registered ICU admissions between 2010 and 2...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: von Oelreich E,Eriksson M,Sjölund KF,Discacciati A,Larsson E,Oldner A

    更新日期:2021-01-28 00:00:00

  • Trauma-hemorrhagic shock-induced red blood cell damage leads to decreased microcirculatory blood flow.

    abstract:OBJECTIVE:To test the hypothesis that trauma-hemorrhagic shock (T/HS)-induced changes in red blood cells (RBC) contribute to the reduction of blood flow in distant organs. DESIGN:Laboratory study. SETTING:Academic medical center laboratory. SUBJECTS:Specific pathogen-free male Sprague-Dawley rats weighing between 25...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Machiedo GW,Zaets SB,Berezina TL,Xu DZ,Feketova E,Spolarics Z,Deitch EA

    更新日期:2009-03-01 00:00:00

  • How to use articles about diagnostic technology: gastric tonometry.

    abstract:PURPOSE:Periodic diagnostic tests and continuous and intermittent monitoring are integral to critical care medicine. The focus of this article is understanding the impact of existing diagnostic technology, as well as that of new diagnostic technology. DATA SYNTHESIS:We use literature about gastric tonometry to illustr...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审


    authors: Keenan SP,Guyatt GH,Sibbald WJ,Cook DJ,Heyland DK,Jaeschke RZ

    更新日期:1999-09-01 00:00:00

  • N-acetylcysteine is effective for prevention but not for treatment of folic acid-induced acute kidney injury in mice.

    abstract:OBJECTIVES:There is controversy regarding the benefits of N-acetylcysteine in acute kidney injury. This study was to compare three commonly used regimens and explore which regimen is best for the protection of acute kidney injury. DESIGN:Prospective experimental study. SETTING:University research laboratory. INTERVE...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Wang HZ,Peng ZY,Wen XY,Rimmelé T,Bishop JV,Kellum JA

    更新日期:2011-11-01 00:00:00

  • Continuous lateral rotation therapy to prevent ventilator-associated pneumonia.

    abstract:OBJECTIVE:To investigate the impact of prophylactic continuous lateral rotation therapy on the prevalence of ventilator-associated pneumonia, duration of mechanical ventilation, length of stay, and mortality in critically ill medical patients. DESIGN:Prospective, randomized, clinical study. SETTING:Three medical inte...

    journal_title:Critical care medicine

    pub_type: 杂志文章,随机对照试验


    authors: Staudinger T,Bojic A,Holzinger U,Meyer B,Rohwer M,Mallner F,Schellongowski P,Robak O,Laczika K,Frass M,Locker GJ

    更新日期:2010-02-01 00:00:00

  • Thrombocytopenia in patients in the medical intensive care unit: bleeding prevalence, transfusion requirements, and outcome.

    abstract:OBJECTIVE:To determine prevalence, risk factors, and outcome of thrombocytopenia in medical intensive care patients. DESIGN:Prospective observational study. SETTING:The 12-bed medical intensive care unit of a university hospital. PATIENTS:All consecutively admitted patients with normal platelet count at admission an...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Strauss R,Wehler M,Mehler K,Kreutzer D,Koebnick C,Hahn EG

    更新日期:2002-08-01 00:00:00

  • Intravenous insulin nomogram improves blood glucose control in the critically ill.

    abstract:OBJECTIVE:To improve control of blood glucose concentrations in critically ill patients through use of a bedside, nurse-managed, intravenous insulin nomogram. DESIGN:Retrospective, before-after cohort study. SETTING:Fifteen-bed mixed medical/surgical intensive care unit in a tertiary, teaching hospital. PATIENTS:A t...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Brown G,Dodek P

    更新日期:2001-09-01 00:00:00

  • Mechanisms of sepsis-induced cardiac dysfunction.

    abstract:OBJECTIVES:To review mechanisms underlying sepsis-induced cardiac dysfunction in general and intrinsic myocardial depression in particular. DATA SOURCE:MEDLINE database. DATA SYNTHESIS:Myocardial depression is a well-recognized manifestation of organ dysfunction in sepsis. Due to the lack of a generally accepted defi...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审


    authors: Rudiger A,Singer M

    更新日期:2007-06-01 00:00:00

  • Frequency, risk factors, and outcomes of early unplanned readmissions to PICUs.

    abstract:OBJECTIVES:To determine the rate of unplanned PICU readmissions, examine the characteristics of index admissions associated with readmission, and compare outcomes of readmissions versus index admissions. DESIGN:Retrospective cohort analysis. SETTING:Ninety North American PICUs that participated in the Virtual Pediatr...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Edwards JD,Lucas AR,Stone PW,Boscardin WJ,Dudley RA

    更新日期:2013-12-01 00:00:00

  • Functional residual capacity measurement by heptafluoropropane in ventilated newborn lungs: in vitro and in vivo validation.

    abstract:OBJECTIVE:Heptafluoropropane is an inert gas commercially used as propellant for inhalers. Since heptafluoropropane can be detected in low concentrations, it could also be used as a tracer gas to measure functional residual capacity and ventilation homogeneity. The aim of the present study was to validate functional re...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Proquitté H,Kusztrich A,Auwärter V,Pragst F,Wauer RR,Schmalisch G

    更新日期:2006-06-01 00:00:00

  • Is worsening multiple organ failure the cause of death in patients with severe sepsis?

    abstract:OBJECTIVES:Although the mortality of severe sepsis is easily quantified, the actual cause and timing of death from severe sepsis are less defined. We used the INDEPTH (International Integrated Database for the Evaluation of Severe Sepsis and Drotrecogin alfa activated) database to investigate the reported cause of deat...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Vincent JL,Nelson DR,Williams MD

    更新日期:2011-05-01 00:00:00

  • Extracellular Mitochondrial DNA and N-Formyl Peptides in Trauma and Critical Illness: A Systematic Review.

    abstract:OBJECTIVES:Extracellular mitochondrial DNA and N-formyl peptides released following tissue damage may contribute to systemic inflammation through stimulation of the innate immune system. In this review, we evaluate existing in vivo human data regarding a role for mitochondrial DNA and N-formyl peptides in producing sys...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Lubkin DT,Bishawi M,Barbas AS,Brennan TV,Kirk AD

    更新日期:2018-12-01 00:00:00

  • Healthcare climate: a framework for measuring and improving patient safety.

    abstract:OBJECTIVES:Reviews of patient safety efforts suggest that technical/administrative change must be augmented by global factors such as organizational culture and climate. The objective was to outline a comprehensive model for healthcare climate and test one of its elements, the nursing subclimate, in terms of several pa...

    journal_title:Critical care medicine

    pub_type: 杂志文章,多中心研究


    authors: Zohar D,Livne Y,Tenne-Gazit O,Admi H,Donchin Y

    更新日期:2007-05-01 00:00:00

  • Use of corticosteroid therapy in patients with sepsis and septic shock: an evidence-based review.

    abstract:OBJECTIVE:In 2003, critical care and infectious disease experts representing 11 international organizations developed management guidelines for the use of corticosteroid therapy in patients with sepsis and septic shock that would be of practical use for the bedside clinician, under the auspices of the Surviving Sepsis ...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审


    authors: Keh D,Sprung CL

    更新日期:2004-11-01 00:00:00

  • Acute hemodynamic effects of controlled oxygen therapy in decompensated chronic obstructive pulmonary disease.

    abstract::The acute effects of controlled O2 therapy on hemodynamics and blood gases were investigated in 22 patients with decompensated chronic obstructive pulmonary disease (COPD). An inspired O2 fraction (FIO2) of 0.24 and 0.28 given to the first 12 patients markedly improved arterial and mixed-venous blood oxygenation with ...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Lejeune P,Mols P,Naeije R,Hallemans R,Melot C

    更新日期:1984-12-01 00:00:00

  • Management of neonatal seizures.

    abstract::Seizures in the neonatal period are usually concomitants of serious neurological disease. The convulsive phenomena take certain distinctive and often subtle forms because of the status of the neuroanatomical and neurophysiological development of the neonatal brain. The predominant etiological process is hypoxic-ischem...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Volpe JJ

    更新日期:1977-01-01 00:00:00

  • Gas exchange and lung inflammation using nasal intermittent positive-pressure ventilation versus synchronized intermittent mandatory ventilation in piglets with saline lavage-induced lung injury: an observational study.

    abstract:OBJECTIVE:Physiologic and pathologic comparison of two modes of assisted ventilation, nasal intermittent positive-pressure ventilation (NIPPV) and synchronized intermittent mandatory ventilation (SIMV), in spontaneously breathing term newborn piglets with saline lavage-induced lung injury. DESIGN:After inducing acute ...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Lampland AL,Meyers PA,Worwa CT,Swanson EC,Mammel MC

    更新日期:2008-01-01 00:00:00

  • Cytomegalovirus seroprevalence as a risk factor for poor outcome in acute respiratory distress syndrome*.

    abstract:OBJECTIVE:Cytomegalovirus reactivation may complicate critical illness in latent carriers of the virus, even in patients who were previously immunocompetent. Patients with acute respiratory distress syndrome are considered to be prone for reactivation. Prophylactic antiviral therapy in immunocompetent cytomegalovirus s...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Ong DS,Klein Klouwenberg PM,Verduyn Lunel FM,Spitoni C,Frencken JF,Dekker HA,Schultz MJ,Bonten MJ,Cremer OL

    更新日期:2015-02-01 00:00:00

  • Soluble triggering receptor expressed on myeloid cells-1 as an infection marker for patients with neutropenic fever.

    abstract:OBJECTIVE:To assess the value of soluble triggering receptor expressed on myeloid cells-1 as a biomarker of infection in patients with neutropenic fever comparing with procalcitonin and C-reactive protein. DESIGN:Prospective, comparative, single-center study. SETTING:Hematology ward at a university hospital. SUBJECT...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Lin CH,Yao M,Hsu SC,Ho CC,Lin MT,Lin CA,Hu FC,Yu CJ,Tien HF

    更新日期:2011-05-01 00:00:00

  • Protecting healthcare workers from pandemic influenza: N95 or surgical masks?

    abstract:OBJECTIVE:The successful management of an influenza pandemic will be reliant on the expertise of healthcare workers at high risk for occupationally acquired influenza. Recommended infection control measures for healthcare workers include surgical masks to protect against droplet-spread respiratory transmissible infecti...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审


    authors: Gralton J,McLaws ML

    更新日期:2010-02-01 00:00:00

  • Transient coagulation abnormalities after incompatible blood transfusion.

    abstract::This report describes an unusual hemolytic transfusion reaction. A group O donor was inadvertently transfused with 100 ml of group A red cells during the course of plasmapheresis. Granulocytopenia, thrombocytopenia, hypofibrinogenemia and low levels of factors V, VIII, and IX developed immediately after the infusion. ...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: McKenna PJ,Scheinman HZ

    更新日期:1975-01-01 00:00:00

  • Interventions to Improve Hand Hygiene Compliance in the ICU: A Systematic Review.

    abstract:OBJECTIVES:To synthesize the literature describing interventions to improve hand hygiene in ICUs, to evaluate the quality of the extant research, and to outline the type, and efficacy, of interventions described. DATA SOURCES:Systematic searches were conducted in November 2016 using five electronic databases: Medline,...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审


    authors: Lydon S,Power M,McSharry J,Byrne M,Madden C,Squires JE,O'Connor P

    更新日期:2017-11-01 00:00:00

  • Total liquid ventilation with perfluorocarbons increases pulmonary end-expiratory volume and compliance in the setting of lung atelectasis.

    abstract:OBJECTIVE:To compare compliance and end-expiratory lung volume during reexpansion of normal and surfactant-deficient ex vivo atelectatic lungs with either gas or total liquid ventilation. DESIGN:Controlled, animal study using an ex vivo lung preparation. SETTING:A research laboratory at a university medical center. ...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Tooley R,Hirschl RB,Parent A,Bartlett RH

    更新日期:1996-02-01 00:00:00