Abstract:
OBJECTIVE:To evaluate the possible effects of a combination of systemic nitric oxide synthesis inhibition (to increase mean arterial blood pressure) and nitric oxide inhalation (to decrease pulmonary vascular pressure) in porcine endotoxin shock. DESIGN:Prospective trial. SETTING:Laboratory at a large university medical center. SUBJECTS:Ten pathogen-free pigs weighing 19 to 25 kg. INTERVENTIONS:After surgical preparation, all pigs received a continuous infusion of Escherichia coli lipopolysaccharide endotoxin (15 micrograms/kg/hr) for 2 hrs. After 1 hr of endotoxemia, nitric oxide inhalation (50 parts per million) and NG-nitro-L-arginine infusion (50 mg/kg/hr) were initiated in six pigs. Four pigs served as controls and received only a lipopolysaccharide infusion. MEASUREMENTS AND MAIN RESULTS:NG-nitro-L-arginine infusion and nitric oxide inhalation prevented the further decrease in mean arterial blood pressure seen in the control pigs (p < .05), but did not restore mean arterial blood pressure back to basal values. Cardiac output decreased significantly compared with controls during NG-nitro-L-arginine infusion/nitric oxide inhalation (p < .01). Systemic vascular resistance, which was below basal values in the controls after 2 hrs of endotoxemia, was markedly increased by NG-nitro-L-arginine/nitric oxide, to higher values than those observed in the basal state (p < .01). In the control pigs, mean pulmonary arterial pressure and pulmonary vascular resistance showed a biphasic increase. In the NG-nitro-L-arginine/nitric oxide treated group, the second phase increase in mean pulmonary arterial pressure did not occur (p < .01). However, there was no difference in pulmonary vascular resistance between the groups. Renal vascular resistance was unchanged in controls, while NG-nitro-L-arginine/nitric oxide induced a four-fold increase in renal vascular resistance (p < .001). There was no statistical difference in urine production between the groups. PaO2 values were higher and PaCO2 tensions were lower in the treated pigs than in the controls. Arterial pH and base excess did not differ. Arterial plasma epinephrine, norepinephrine, and neuropeptide Y concentrations increased during the lipopolysaccharide infusion in both groups, with a tendency toward higher concentrations in the pigs receiving NG-nitro-L-arginine/nitric oxide. Arterial plasma endothelin-1-like immunoreactivity in these pigs was significantly higher at the end of the treatment than in the controls. CONCLUSIONS:In this model of porcine endotoxin shock, the combination of NG-nitro-L-arginine infusion and nitric oxide inhalation attenuated pulmonary hypertension and improved gas exchange; it also prevented development of further systemic hypotension, but impaired cardiac output and increased systemic and renal vascular resistances to supranormal levels. NG-nitro-L-arginine/nitric oxide did not reduce sympathetic nervous system activation or metabolic acidosis.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Weitzberg E,Rudehill A,Modin A,Lundberg JMdoi
10.1097/00003246-199505000-00020subject
Has Abstractpub_date
1995-05-01 00:00:00pages
909-18issue
5eissn
0090-3493issn
1530-0293journal_volume
23pub_type
杂志文章abstract:OBJECTIVES:The American College of Critical Care Medicine provided 2002 and 2007 guidelines for hemodynamic support of newborn and pediatric septic shock. Provide the 2014 update of the 2007 American College of Critical Care Medicine "Clinical Guidelines for Hemodynamic Support of Neonates and Children with Septic Shoc...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002425
更新日期:2017-06-01 00:00:00
abstract:OBJECTIVES:To review the reports of prolonged neuromuscular blockade secondary to vecuronium and atracurium administration. To propose mechanisms for prolonged blockade, as well as methods to avoid prolonged blockade. DATA SOURCES:A literature search was conducted of articles published from 1980 to 1993. Articles pert...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/00003246-199405000-00028
更新日期:1994-05-01 00:00:00
abstract:OBJECTIVE:To determine whether preoperative plasma levels of B-type natriuretic peptide would allow for the prediction of perioperative and early postoperative cardiovascular support requirements and hospital bed usage after coronary artery surgery. DESIGN:A prospective observational cohort study. SETTING:A tertiary ...
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abstract:OBJECTIVE:To describe a case of intentional ingestion of hand sanitizer in our hospital and to review published cases and those reported to the American Association of Poison Control Centers' National Poison Data System. DESIGN:A case report, a literature review of published cases, and a query of the National Poison D...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e31822f09c0
更新日期:2012-01-01 00:00:00
abstract:OBJECTIVES:The aim of this study was to test the hypothesis that the right ventricle is more dilated during resuscitation from cardiac arrest caused by pulmonary embolism, compared with hypoxia and primary arrhythmia. DESIGN:Twenty-four pigs were anesthetized and cardiac arrest was induced using three different method...
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更新日期:2008-06-01 00:00:00
abstract:OBJECTIVES:Previous workers have demonstrated that controlled mechanical ventilation results in diaphragm inactivity and elicits a rapid development of diaphragm weakness as a result of both contractile dysfunction and fiber atrophy. Limited data exist regarding the impact of pressure support ventilation, a commonly us...
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doi:10.1097/CCM.0b013e31826ab3a1
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abstract:OBJECTIVE:To review the rationale for the regionalization of adult critical care and discuss how lessons from the trauma experience may be relevant to this debate. DESIGN:Narrative review and opinion. RESULTS:Variation in the quality of critical care among hospitals has prompted calls for regionalization of care for ...
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更新日期:2010-12-01 00:00:00
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更新日期:2006-03-01 00:00:00
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更新日期:2018-01-01 00:00:00
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doi:10.1097/00003246-199712000-00017
更新日期:1997-12-01 00:00:00
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doi:10.1097/00003246-200007000-00068
更新日期:2000-07-01 00:00:00
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doi:10.1097/CCM.0000000000000144
更新日期:2014-05-01 00:00:00
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doi:10.1097/CCM.0b013e31820ead5e
更新日期:2011-05-01 00:00:00
abstract:OBJECTIVE:To determine the maternal morbidity and mortality in patients with eclampsia admitted to an intensive care unit (ICU), and to establish the efficacy of the Acute Physiology and Chronic Health Evaluation (APACHE) II score, the organ system failure score as defined by Knaus, and the Glasgow Coma Scale (GCS) sco...
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doi:10.1097/00003246-200001000-00020
更新日期:2000-01-01 00:00:00
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doi:10.1097/00003246-199906000-00026
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更新日期:2008-06-01 00:00:00
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doi:10.1097/00003246-199409000-00017
更新日期:1994-09-01 00:00:00
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更新日期:2020-02-01 00:00:00
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更新日期:2008-04-01 00:00:00
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pub_type: 杂志文章,多中心研究
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更新日期:2008-08-01 00:00:00
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pub_type: 共识发展会议,杂志文章,评审
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更新日期:2003-04-01 00:00:00
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更新日期:2009-07-01 00:00:00
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更新日期:2008-10-01 00:00:00