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Role of Nitric Oxide in Pulmonary Vascular Dysfunction

  • M. J. D. Griffiths
  • T. W. Evans
Part of the Update in Intensive Care and Emergency Medicine book series (UICM, volume 24)

Abstract

Early descriptions of patients with septic shock in which invasive monitoring was used emphasized the failure of a sustained response of the central venous pressure and cardiac output to volume replacement indicating pathological dilation of peripheral blood vessels [1]. Apart from the hemodynamic changes associated with shock, metabolic derangement and failure of multiple organ systems, including acute lung injury (ALI), were recorded in the majority of patients. Since early reports that a calcium-independent nitric oxide synthase (NOS) could be induced by endotoxin (LPS) and proinflammatory cytokines in extra-endothelial vascular tissue [2], considerable evidence(vide supra) has accumulated implicating nitric oxide (NO), derived from inducible iNOS, as a final mediator of sepsis-associated vasodilation and hyporesponsiveness to vasopressors. More recently, with the increasing awareness of the importance of oxygen delivery in determining the outcome of patients with sepsis, attention has focused on the regional distribution of blood flow both at an organ system and microcirculatory level. In this chapter, the evidence implicating the L-arginine/NO pathway as an important effector of sepsis-induced pulmonary vascular dysfunction is discussed.

Keywords

Nitric Oxide Acute Lung Injury Systemic Inflammatory Response Syndrome Adult Respiratory Distress Syndrome Hypoxic Pulmonary Vasoconstriction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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© Springer-Verlag Berlin Heidelberg 1995

Authors and Affiliations

  • M. J. D. Griffiths
  • T. W. Evans

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