Document Detail


Nitric oxide synthase inhibition by L-NAME in leukocytopenic patients with severe septic shock.
MedLine Citation:
PMID:  9201529     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To investigate the effects of nitric oxide synthase inhibition by NG-nitro-L-arginine methyl ester (L-NAME) on hemodynamics and outcome in leukocytopenic (< 1000/microliter) patients with severe septic shock requiring strong vasopressor support. DESIGN: Prospective clinical study. SETTING: Medical intensive care unit. PATIENTS: 10 patients with hematologic malignancies in chemotherapy-induced leukocytopenia with severe septic shock and high-dose vasopressor requirement. INTERVENTION: Continuous intravenous infusion of L-NAME (0.3 mg/ kg per hour) for a study period of 24 h with prolongation for up to 96 h according to individual requirements. MEASUREMENTS AND RESULTS: Compared to baseline values, an increase in mean arterial pressure (p = 0.0021), systemic vascular resistance (p = 0.0001), and left ventricular stroke work index (p = 0.023) with a concomitant decrease in vasopressor requirement (p < 0.05) was observed during the first 24 h of L-NAME treatment. Cardiac output data were unchanged during the study period (p = 0.49). L-NAME was tapered off in five patients who again became responsive to vasopressor medication. Two patients survived the episode of septic shock and vasoactive medication was stopped. CONCLUSIONS: The data demonstrate that inhibition of nitric oxide synthase may be beneficial for the treatment of severe septic shock in leukocytopenic patients as indicated by an increase in systemic vascular resistance, mean arterial pressure, and left ventricular stroke work index.
Authors:
M G Kiehl; H Ostermann; J Meyer; J Kienast
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Intensive care medicine     Volume:  23     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  1997 May 
Date Detail:
Created Date:  1997-08-15     Completed Date:  1997-08-15     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  561-6     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine, University of Muenster, Germany.
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MeSH Terms
Descriptor/Qualifier:
Adult
Analysis of Variance
Antineoplastic Agents / adverse effects
Blood Pressure / drug effects
Enzyme Inhibitors / therapeutic use*
Female
Heart Ventricles / drug effects
Hematologic Neoplasms / complications,  drug therapy
Hemodynamics / drug effects*
Humans
Leukopenia / chemically induced,  complications*
Male
Middle Aged
NG-Nitroarginine Methyl Ester / therapeutic use*
Nitric Oxide Synthase / antagonists & inhibitors*
Prospective Studies
Shock, Septic / drug therapy*,  etiology
Stroke Volume / drug effects
Treatment Outcome
Vascular Resistance / drug effects
Vasoconstrictor Agents / therapeutic use
Chemical
Reg. No./Substance:
0/Antineoplastic Agents; 0/Enzyme Inhibitors; 0/Vasoconstrictor Agents; 50903-99-6/NG-Nitroarginine Methyl Ester; EC 1.14.13.39/Nitric Oxide Synthase

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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