| Summary: | Administering N-acetylcysteine (NAC) could counteract the effect of free radicals, improving the clinical evolution of patients admitted to the Intensive Care Unit (ICU). This study aimed to investigate the clinical and biochemical effects of administering NAC to critically ill patients with COVID-19. A randomized controlled clinical trial was conducted on ICU patients (<i>n =</i> 140) with COVID-19 and divided into two groups: patients treated with NAC (NAC-treated group) and patients without NAC treatment (control group). NAC was administered as a continuous infusion with a loading dose and a maintenance dose during the study period (from admission until the third day of ICU stay). NAC-treated patients showed higher PaO<sub>2</sub>/FiO<sub>2</sub> (<i>p ≤</i> 0.014) after 3 days in ICU than their control group counterparts. Moreover, C-reactive protein (<i>p ≤</i> 0.001), D-dimer (<i>p ≤</i> 0.042), and lactate dehydrogenase (<i>p ≤</i> 0.001) levels decreased on the third day in NAC-treated patients. Glutathione concentrations decreased in both NAC-treated (<i>p ≤</i> 0.004) and control (<i>p ≤</i> 0.047) groups after 3 days in ICU; whereas glutathione peroxidase did not change during the ICU stay. The administration of NAC manages to improve the clinical and analytical response of seriously ill patients with COVID-19 compared to the control group. NAC is able to stop the decrease in glutathione concentrations.
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