Nitric oxide production in critically ill patients.
OBJECTIVE
To measure serum nitrite and nitrate levels in critically ill children as indicators of endogenous nitric oxide (NO) production.


OBJECTIVE
Endogenous NO production is increased in children with conditions characterised by immune stimulation.


METHODS
Prospective descriptive study in a multidisciplinary paediatric intensive care unit.


METHODS
137 consecutive critically ill children with a variety of clinical conditions.


METHODS
Using a rapid microtitre plate technique, daily serum nitrite and nitrate levels were measured from serum samples that remained in the clinical laboratory after daily routine phlebotomy. Clinical and laboratory information was also gathered daily for each patient.


RESULTS
The maximum serum nitrite plus nitrate levels (microM) reached by children with infection (41.8 (SD 18.1)), sepsis syndrome (85.1 (39.9)), shock without sepsis (36.4 (19.1)), transplantation alone (61.0 (43.4)), transplantation with sepsis (200.7 (150.5)), or rejection (161.7 (70.4)), were higher than in controls (18.1 (9.3)). In the absence of exogenous NO donors, levels greater than 80 microM were reached only in children with the sepsis syndrome, organ transplantation, or acute rejection.


CONCLUSIONS
Increased endogenous NO production occurs in children with clinical conditions associated with immune stimulation. Further investigation is warranted to determine the value of this simple and rapid test as a clinically useful diagnostic tool and therapeutic monitor in the evaluation of children at risk for the sepsis syndrome or acute allograft rejection.
Wong
H R
HR
Department of Anesthesiology, University of Pittsburgh School of Medicine, PA 15213, USA.
Carcillo
J A
JA
Burckart
G
G
Kaplan
S S
SS
D002648:Child; D016638:Critical Illness; D006084:Graft Rejection / Q000378:metabolism; D006801:Humans; D007239:Infections / Q000378:metabolism; D009566:Nitrates / Q000097:blood; D009569:Nitric Oxide / Q000096:biosynthesis*; D009573:Nitrites / Q000097:blood; D016377:Organ Transplantation / Q000502:physiology; D011446:Prospective Studies; D012016:Reference Values; D012769:Shock / Q000378:metabolism; D018746:Systemic Inflammatory Response Syndrome / Q000378:metabolism
D009566:Nitrates; D009573:Nitrites; D009569:Nitric Oxide