Evaluation of nebulized N-acetyl cysteine in outcome of esophageal atresia with tracheoesophegeal fistula.

Abstract Aim To evaluate the role of nebulized N-Acetyl Cysteine (NAC) in liquefying the airway secretions and improving the outcome of patients of esophageal atresia with tracheaesophageal fistula (EA + TEF). Methods It was a non-randomized interventional study. Two ml of 10% NAC was given in a nebulized form (2:5 dilution, every six hourly) to patients of ET + TEF, along with regular suction of upper esophageal pouch. The group was compared with control, which comprised patients of EA + TEF receiving only saline nebulization. The consistency of the secretions was compared by hand held consistometer in unit of time (seconds) required to cross a predetermined distance along with gravity. Results Sixty patients were assessed. Of these, 30 patients were present in both groups. The study group showed significant (p = 0.01 to 0.0001) decrease in consistency of secretions from the control group after day 2 of NAC nebulization. Patients' discharge was significantly (p = 0.01) earlier in cases. There was no significant (p = 0.41) difference in mortality between the groups. No specific adverse effects were observed in the study group. Conclusion It appears that nebulized NAC decreases the consistency of secretions in EA + TEF patients. It is interesting to note that the group of patients that received NAC was discharged earlier than the control group and had a higher survival rate than the control group. Whether this is directly attributable to the use of NAC is unknown. A prospective double-blinded randomized clinical trial is warranted to confirm these results. Level of evidence level II, prospective comparative study (non-randomized).