title: Delayed administration of inhaled nitric oxide preserves alveolar-capillary membrane integrity in porcine gram-negative sepsis.
abstract: OBJECTIVE
  To determine the effect of delayed administration of inhaled nitric oxide (NO) on acute lung injury after the onset of gram-negative sepsis.
  
  
  METHODS
  Nonrandomized controlled study.
  
  
  METHODS
  University medical center laboratory.
  
  
  METHODS
  Yorkshire swine.
  
  
  METHODS
  Five groups of swine were anesthetized, mechanically ventilated, and studied for 5 hours. After surgical preparation, control (n = 10) and NO-treated control (n = 6) animals received a 1-hour infusion of sterile saline solution. Sepsis was induced with a 1-hour intravenous infusion of live Pseudomonas aeruginosa. Untreated animals with sepsis (n = 10) received no treatment. Inhaled NO at 20 ppm was administered to NO30-treated animals with sepsis (n = 7) and NO60-treated animals with sepsis (n = 8) beginning at 30 and 60 minutes after bacterial infusion was begun, respectively.
  
  
  METHODS
  Systemic and pulmonary hemodynamics, arterial blood gas determination, bronchoalveolar lavage protein and neutrophil content, neutrophil oxidant burst, lung myeloperoxidase content, and scanning electron micrographic studies.
  
  
  RESULTS
  A progressive, significant (P < .05) decline in PaO2 developed in untreated animals with sepsis, which was prevented in NO30- and NO60-treated animals with sepsis. A significant (P < .05) increase in bronchoalveolar lavage protein and neutrophil counts compared with baseline values was observed in untreated animals with sepsis, indicating acute lung injury. These variables exhibited no notable increase in NO30- and NO60-treated animals with sepsis and were significantly (P < .05) reduced compared with untreated animals with sepsis. The lung myeloperoxidase content was significantly (P < .05) elevated at 5 hours in all groups with sepsis compared with baseline values and the control and NO-treated control groups. The total phorbol myristate acetate-induced polymorphonuclear leukocyte oxidant burst at 5 hours was significantly (P < .05) decreased in the NO30- and NO60-treated animals with sepsis compared with untreated animals with sepsis. Untreated and NO30- and NO60-treated animals with sepsis showed a significant (P < .05) increase in pulmonary artery pressure at 30 minutes, followed by a progressive decline. These changes were significant (P < .05) compared with baseline values and the control groups. No significant (P < .05) difference in pulmonary artery pressure or systemic arterial pressure was found at any time between untreated and NO30- and NO60-treated animals with sepsis.
  
  
  CONCLUSIONS
  The delayed administration of inhaled NO preserves alveolar-capillary membrane integrity in this porcine model of gram-negative sepsis. The inhibition of neutrophil transendothelial migration, rather than neutrophil rolling or tight adhesion, may be a critical mechanism by which inhaled NO produces this effect. Decreased oxidant production by activated neutrophils may be a secondary mechanism by which inhaled NO reduces acute lung injury.
authors.affiliation: Department of Surgery, Medical College of Virginia, Virginia Commonwealth University, Richmond, USA.
authors.forename: G L
authors.initials: GL
authors.lastname: Bloomfield
authors.forename: L B
authors.initials: LB
authors.lastname: Sweeney
authors.forename: B J
authors.initials: BJ
authors.lastname: Fisher
authors.forename: C R
authors.initials: CR
authors.lastname: Blocher
authors.forename: M M
authors.initials: MM
authors.lastname: Sholley
authors.forename: H J
authors.initials: HJ
authors.lastname: Sugerman
authors.forename: A A
authors.initials: AA
authors.lastname: Fowler
mesh_terms: D000818:Animals; D015824:Blood-Air Barrier / Q000187:drug effects*; D016905:Gram-Negative Bacterial Infections / Q000503:physiopathology*; D006439:Hemodynamics / Q000187:drug effects; D008168:Lung / Q000737:chemistry / Q000648:ultrastructure; D009504:Neutrophils / Q000187:drug effects / Q000502:physiology; D009569:Nitric Oxide / Q000494:pharmacology*; D009195:Peroxidase / Q000032:analysis; D011652:Pulmonary Circulation / Q000187:drug effects; D018805:Sepsis / Q000503:physiopathology*; D013552:Swine; D013997:Time Factors
chemical_list: D009569:Nitric Oxide; D009195:Peroxidase