Carbocisteine or Hypertonic Saline for Acute Respiratory Failure.

Carbocisteine and hypertonic saline do not significantly reduce mechanical ventilation duration in critically ill patients with acute respiratory failure, and each pose potential harms.

• Why it matters: Effective treatments for reducing ventilation time in acute respiratory failure are limited, and the widespread use of mucoactive agents lacks solid evidence of safety and benefit, highlighting the need for rigorous evaluation.
• What they did: A multicenter, open-label, randomized trial involving 1956 critically ill, mechanically ventilated patients tested carbocisteine and hypertonic saline, alone or combined, against usual care, measuring ventilation duration as the primary outcome.
• The result: Neither intervention shortened ventilation time significantly; carbocisteine increased gastrointestinal bleeding risk, and hypertonic saline increased bronchoconstriction and hypoxemia, indicating potential harms without clear benefits.