Monday January 7, 2008
Mucomyst - does it work ? - yes, no, yes, no ?
Helps kidney or lung or liver ?

Since landmark 2000 article of NEJM 1 on benefit of antioxidant, N-acetylcysteine (mucomyst) on prevention of acute renal failure in many clinically stress situations, it has almost became a standard of practice. Since than though many studies failed to show its benefit and strictly from evidence based medicine, it has yet to prove its role !

This month, another study published from Italy in Critical Care Medicine 2, on benefit of N-acetylcysteine for prevention of acute renal failure in patients with chronic renal insufficiency undergoing cardiac surgery.

Randomized, placebo-controlled, prospective study of 254 consecutive patients with chronic renal insufficiency (estimated cr. cl. less than or = 60 mL/min) undergoing elective cardiac surgery wwas done. Patients were randomized into 2 groups

• to receive N-acetylcysteine (n = 129). Patients of the N-acetylcysteine group received four boluses of intravenous N-acetylcysteine (1200 mg every 12 hrs, starting immediately before cardiac surgery).
• or placebo (n = 125)

Postoperative acute renal failure is defined as more than 25% increase in serum creatinine from baseline.


Results:

• Acute renal failure occurred in occurred in 52% of control patients and 40% of N-acetylcysteine-treated patients (p = .06)
• In-hospital mortality and need for renal replacement therapy were not affected by N-acetylcysteine
• N-acetylcysteine-treated patients required less days of mechanical ventilation prolonged for >48 hrs (3% vs. 18%; p < .001)
• N-acetylcysteine-treated patients had lower incidence of prolonged stay in intensive care unit stay, defined as more than 4 days (13% vs. 33%; p < .001)

Conclusions:

Though IV mucomust does not clearly prevent postoperative acute renal failure in patients with renal insufficiency undergoing cardiac surgery, it suggests a positive effect of NAC on pulmonary function that influences a patient's clinical course by having lower days of mechanical ventilation and so lower ICU-LOS !

Editors' comment: Use it !


Related previous pearls:

Double the dose of mucomyst? ,
Contrast induced Nephropathy and
Preventing contrast-Induced Nephropathy - use of sodium bicarbonate



References: click to get abstract / article

1. Prevention of Radiographic-Contrast-Agent–Induced Reductions in Renal Function by Acetylcysteine - N Engl J Med 343:180, July 20, 2000
2. N-acetylcysteine for prevention of acute renal failure in patients with chronic renal insufficiency undergoing cardiac surgery: A prospective, randomized, clinical trial - Critical Care Medicine. 36(1):81-86, January 2008