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#5-51E. Rethinking Mucoactives in the ICU: Key Insights from the MARCH Trial (NEJM, 2026)
2026年8月31日 12:00·6分7秒
Are we truly helping mechanically ventilated patients by routinely administering mucoactive agents? The multicenter MARCH trial reveals that adding carbocisteine or hypertonic saline to standard care does not shorten the duration of mechanical ventilation. Instead, carbocisteine significantly increased clinically important gastrointestinal bleeding, while hypertonic saline led to higher rates of bronchoconstriction and transient hypoxemia. Although these findings are limited by the trial’s open-label design, which might introduce bias in ventilator weaning decisions, they strongly challenge current clinical dogmas. This study urges intensivists to reconsider these customary but potentially low-value treatments, enhancing patient safety in critical care.
Citation: Connolly B, Dickson N, Campbell C, et al. Carbocisteine or Hypertonic Saline for Acute Respiratory Failure. The New England Journal of Medicine. 2026. DOI: 10.1056/NEJMoa2603406
URL: https://doi.org/10.1056/NEJMoa2603406
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