N-acetylcysteine in clinical sepsis: a difficult marriage.

The high morbidity and mortality of severe sepsis and septic shock fosters a continuous search for novel therapies that go beyond pure correction of oxygenation and hemodynamics. Within this scope, N-acetylcysteine shows great promise. Beside proven anti-oxidant, anti-inflammatory and cytoprotective effects, N-acetylcysteine does also ensure endothelial protection and enhances microvascular blood flow. Studies that put these highly favourable properties to the clinical test remain scarce but are definitely needed to determine whether N-acetylcysteine has a place in our therapeutic armamentarium against sepsis.