1. Active indication and use of NAC 2. Known allergy to NAC 3. In the opinion of the clinical team, progression to death is imminent and inevitable within the next 24 hours, irrespective of provision of treatment e.g. patients on ECMO at time of randomization 4. Patients enrolled in other investigational drug studies are not eligible for our study

1. Active indication and use of NAC 2. Known allergy to NAC 3. In the opinion of the clinical team, progression to death is imminent and inevitable within the next 24 hours, irrespective of provision of treatment e.g. patients on ECMO at time of randomization 4. Patients enrolled in other investigational drug studies are not eligible for our study