N-acetylcysteine and cardiac dysfunction in human septic shock

Abstract

Objective: To determine which patients in septic shock may develop myocardial depression during adjuvant therapy with N-acetylcysteine (NAC). Design: Open, interventional study. Setting: Medicosurgical intensive care unit in a university hospital. Subjects: Twelve consecutively enrolled patients with acute pneumonia-induced septic shock. Interventions: Following fluid and catecholamine resuscitation, all patients received NAC as a 150 mg/kg bolus over 15 min, followed by a continuous infusion of 50 mg/kg/4 h and 100 mg/kg/16 h. Measurements and main results: Assessment of left ventricular (LV) function by transoesophageal echocardiography and plasma measurements of cardiac troponin I (cTnI) were performed after haemodynamic stabilization and repeated 24 h later. Total plasma NAC amount was measured by HPLC before administration and 0.5, 2, 6 and 24 h post-infusion. Six patients were cTnI-positive (cTnI values exceeding 0.4µg/l) at baseline (mean value 3.8(0.5-12.3)µg/l) and at 24h (mean value 4.7(0.7-17...