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L-arginine: nitric oxide pathway in endotoxemia and human septic shock
J Gómez-Jiménez1, A Salgado, M Mourelle
1Critical Care Unit, Hospital General Vall d'Hebron, Autonomous University of Barcelona, Spain.
Objective:
To investigate the relationship between nitric oxide production, endotoxemia, and hemodynamic alterations in human septic shock.
Design:
Prospective study.
Setting:
A 32-bed intensive care unit in a university referral hospital.
Patients:
Two groups of septic patients with shock (n = 13) or without shock (n = 16) and an additional group of nonseptic patients as control group (n = 25).
Measurements:
Plasma nitrite and nitrate concentrations were measured as an index of nitric oxide generation. Nitrite and nitrate concentrations were correlated with plasma endotoxin and hemodynamic variables.
Main Results:
Increased plasma nitrite and nitrate concentrations were found in patients with septic shock (p < .01). Nitrite and nitrate correlated directly with endotoxin concentration (r2 = .21, p < .05) and cardiac output (r2 = .49, p < .05), and inversely with systolic blood pressure (r2 = .24, p < .01).
Conclusions:
This study demonstrated the activation of the L-arginine:nitric oxide pathway in human endotoxemic septic shock, suggesting that nitric oxide may be an important mediator of the hemodynamic disturbances in this pathophysiologic situation.