Clinical studies on the mucolytic effect of mesna

Eighty intensive care patients requiring mucolytic therapy because of pulmonary mucus retention after chest (28 cases) or thoracic (52 cases) surgery were given the drug mesna by three different methods: bronchial lavage with a mixture of mesna (5% to 10%) and lidocaine (1%) in 15 to 20 ml, 10 to 20 times a day (10 cases); instillation into the bronchial tree of 15 to 20 ml of a 5% to 10% mesna solution three to five times a day (20 cases); continuous aerosolization of four to five ampules of mesna per 24 hours with a Bennett nebulizer (50 cases). The duration of mesna therapy ranged from 2 to 21 days. The drug was found to be highly effective in all three methods; rapid fluidization of bronchial secretions was observed and aspiration of the latter was considerably facilitated. Tolerance was excellent and there were no side effects, even in cases with bronchial asthma. A particularly good effect was seen on blood-contaminated mucus. Samples of aspirated mucus were investigated by the electron spin resonance (ESR) technique to obtain structural information about the effects of mesna as compared with N-acetylcysteine. Mucolytics decrease with ESR signal, and the rate of reduction is supposed to measure the rupture of disulphide bridges and, consequently, the degree of mucus fluidization. The rate of decrease of the ESR signals is much higher after mesna.