الفهرس 
N-Acetylcysteine (NAC)Only 14 pages are availabe for public view
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Abstract
The term “inhalation injury” describes the aspiration of superheated gas and toxic products of incomplete combustion. The pathophysiology includes variable degrees of airway edema from direct thermal injury, bronchospasm from aerosolized irritants, small airway occlusion from sloughed endobronchial debris enriched with fibrin (“casts”), and alveolar flooding from epithelial disruption. The clinical consequences are airway obstruction and bronchospasm, usually manifest within the first 24 hrs, and intrapulmonary shunting, diminished compliance, and pulmonary infection, usually developing over the subsequent several days. Inhalation injury commonly accompanies burning and is a major determinant of length of intensive care unit stay and source of morbidity and mortality (Karlonski et al, 2007).
The diagnosis of inhalation injury is largely clinical, based on history (closed space exposure) and physical examination (singed nasal hairs and carbonaceous endobronchial secretions), supported by bronchoscopy (endobronchial erythema and ulceration) (Boots et al, 2009).
At present, there are no specific therapies for inhalation injury. Treatment is supportive only and consists of intubation for standard indications, positive pressure ventilation, pulmonary toilet, and antibiotics for established infection (Karlonski et al, 2007).
Attempts had made to actually influence the natural history of the disease process through using nebulized heparin and N-acetylcysteine. Heparin has anticoagulant and fibrinolytic properties as well as anti-inflammatory effects (Hofstra et al., 2008) and NAC has antioxidant and mucolytic properties (Demling, 2008).
This study was carried out to evaluate and compare the effect of nebulized heparin and N-acetylcysteine on patients with burn inhalation injuries in comparison to the control group receiving normal saline nebulization.
Our study involved 100 patients from Burn Intensive Care Unit, Ain Shams University Hospital. Patients were classified into 4 groups according to nebulized drug into Heparin, NAC, Heparin/NAC (NH) and control groups (received nebulized saline).
This study has revealed that nebulized heparin or N-Acetylcysteine reduces the overall inhalation injury severity score together with reduction in other individual scores (chest X- ray , PIP, P/F ratio and bronchoscopy scores) in burn patients with smoke inhalation injury during the first week of treatment with nebulized combination of heparin/NAC being more effective than either drug alone and concluded that the use of nebulized N-Acetylcysteine and nebulized heparin have a potential therapeutic benefits.
This study recommends the use of nebulized Heparin/N-acetylcysteine in the treatment protocol of patients with smoke inhalation injury.