EFFECTS OF EARLY USE OF N-ACETYLCYSTEINE INFUSION IN SEVERE SEPSIS

The purpose of present study was to study the effects of early use of N-AcetylCysteine (NAC) infusion on hemodynamics,serum cytokines level(TNF- alpha) ,microalbuminurea,intramucosal PH in patients with severe sepsis. Methods: sixty patients who met the criteria of severe sepsis were included in the study within 6 hours of I.C. U admission.In theNAC group(n-30), after initial intravenous dose of 50 mg/kg over 4hours ,a continuous intravenous infusion of 100mg/kg/24hours for 44 hours (total infusion time 48hours) was given.Patients in the control group (n=30) were administered same dosage of isotonic saline 0.9% for 48 hours.The following was recorded:hemodynamic parameters, nasopharyngeal temperature, WBCS,CRP and Tumour necrosis -alpha levels, intamucosal gastric PH Microalbuminuria/creatinine ratio, length of stay in I.C.U , duration of mechanical ventilation and mortality.All measurements were taken at base line(30 min before the start of the study) and we repeated again after 4hours at the end of starting dose infusion,and at 24 and 48hours after initiation of the continuous NAC infusion. Results:patients in NAC group showed significant improvement in hemodynamics during the first 48hours with significant decline in temperature ,total leucocytic count, CRP and TNF- alpha levels with significant decline in microalbuminuria and increase in gastricPH(p 0.05 ).However there was no significant difference between the two groups regarding duration of mechanical ventilation ,length of I.C.U stay and mortality rate(p 0.05 ).Conclusion:we found that NAC infusion at the doses given in early sepsis did affect hemodynamics TNF- alpha levels, microalbuminuria and gastric PH during the first 48 hours with no effect on patient outcomes.Because of limited number of patients,shorted duration of infusion,local trapping of cytokines ,our findings require confirmation in larger clinical trials of NAC infused in a dose titrated manner with longer period of observation and studding the effects of the NAC infusion on other cytokines and other systemic oxygenation parameters.However,we do support the early use of NAC in severe sepsis.