Research news
Two drugs routinely used to help clear airway secretions in critically ill patients receiving mechanical ventilation may be doing more harm than good, according to a major UK clinical trial [1] led by researchers at Queen’s University Belfast.
The MARCH trial, funded by the National Institute for Health and Care Research (NIHR), found that neither carbocisteine nor hypertonic saline reduced the time patients spent on mechanical ventilation. Both treatments were associated with adverse effects, raising questions over their continued routine use in intensive care units.
Published in the New England Journal of Medicine and presented at the Critical Care Reviews Meeting 2026 in Belfast, the study recruited almost 2,000 patients across 71 UK sites. Researchers assessed carbocisteine and hypertonic saline, individually and in combination, in critically ill patients with acute respiratory failure and thick airway secretions.
Mechanical ventilation is widely used to support patients with severe respiratory failure but can impair the lungs’ natural ability to clear secretions. Both drugs are commonly used in ICUs worldwide in an effort to improve airway clearance and reduce ventilation duration.
However, the trial found no evidence that either treatment improved patient outcomes. Carbocisteine was associated with an increased risk of gastrointestinal bleeding, while hypertonic saline was linked to higher rates of nebulisation-related adverse events.
Professor Bronwen Connolly, Chief Investigator at Queen’s University Belfast, said: “Our findings show that neither treatment benefited critically ill patients receiving mechanical ventilation, while both were associated with harm. These results highlight the need for caution in clinical practice.”
The researchers say the findings should inform future clinical guidelines and help ensure critically ill patients receive treatments that are both effective and safe.
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