Systemic inflammatory response, bacterial translocation and nitric oxide donors

Area of Science:

• Vascular Surgery
• Surgical Critical Care
• Inflammation and Immunology

Background:

• Abdominal aortic surgery frequently leads to significant post-operative complications, including Systemic Inflammatory Response Syndrome (SIRS) and Ischemia-Reperfusion (I-R) injury.
• Aortic cross-clamping, essential for graft insertion, can trigger these responses, impacting organs like kidneys and intestines, especially during hemorrhagic shock from ruptured aneurysms.
• Bacterial translocation (BT) is another risk associated with aortic cross-clamping below the mesenteric artery.

Purpose of the Study:

• To review the current status and authors' experience with nitric oxide donors in managing complications of aortic cross-clamping.
• To evaluate the efficacy of nitric oxide donors in controlling SIRS and minimizing I-R injury.
• To assess their role in preventing renal dysfunction and bacterial translocation (BT) during and after aortic surgery.

Main Methods:

• Review of experimental data on exogenous nitric oxide donors' effects on SIRS and I-R.
• Analysis of clinical experience with nitric oxide donors in patients undergoing infrarenal and suprarenal aortic cross-clamping.
• Focus on scenarios with and without hemorrhagic shock and associated bacterial translocation.

Main Results:

• Experimental studies indicate nitric oxide donors can control SIRS and reduce I-R damage.
• These agents show potential in protecting against renal dysfunction and bacterial translocation.
• However, extensive clinical data in this specific surgical context remains limited.

Conclusions:

• Nitric oxide donors show promise in mitigating SIRS and I-R syndromes following aortic surgery.
• Their application may offer protection against organ damage and bacterial translocation.
• Further clinical research is warranted to establish their definitive role in patient management.