The effect of endotracheal administration of N-acetyl cysteine and heparin on the level of secretion and partial hromboplastin time in acute respiratory distress syndrome patients under mechanical ventilation: A randomized clinical trial study

Background and aims: Acute respiratory distress syndrome (ARDS) treatment is supportive, and there is no currently approved treatment for it. This study, therefore, aimed to investigate the effect of endotracheal administration of N-acetyl cysteine (NAC) and heparin on the level of secretion and partial thromboplastin time (PTT) in ARDS patients under mechanical ventilation. Methods: In this clinical trial study, ۷۰ patients aged over ۱۸ years (۳۰ women and ۴۰ men) admitted to the intensive care unit were randomly selected following the allocation rule and then divided into two groups (intervention and control). In addition to the routine and available treatments in the ward given to the patients in both groups, the control group also received ۱۰ mL of normal saline every six hours through the endotracheal route, while the intervention group received ۵۰۰ units of heparin plus ۲۰۰ mg of NAC dissolved in ۱۰ mL of normal saline every six hours through the same administration route. Results: The mean and standard deviation levels of PTT in the control and intervention groups were ۳۰.۳۷۴۳ ± ۷.۷۸۰۰۸ and ۳۲.۲۲۸۶ ± ۸.۳۱۰۴۷, respectively, with no significant difference (P>۰.۰۵); the volume of secretion on days ۱-۳ was not significantly different between the two groups, but the difference was statistically significant from day ۴ onwards (P < ۰.۰۵). Conclusion: Taking the combination of NAC and heparin through the endotracheal route was effective in reducing pulmonary secretion, and may have been considered a considerable positive step in providing patients suffering from acute respiratory failure and under mechanical ventilation with supportive care. However, it is recommended that further clinical studies be conducted before arriving at any definitive conclusion.

Keywords:

Acute respiratory failure , N-acetyl cysteine , Heparin , Mechanical ventilation