Inhaled nitric oxide reduces lung edema during fluid resuscitation in ovine acute lung injury.
OBJECTIVE
Fluid resuscitation in sepsis-related lung injury is limited by aggravation of pulmonary edema. Hypovolemia, however, may compromise tissue perfusion and contribute to organ dysfunction. We hypothesized that inhaled nitric oxide would reduce edema formation during fluid therapy.


METHODS
Prospective laboratory investigation in a university research laboratory.


METHODS
Eighteen chronically instrumented sheep.


METHODS
The animals were randomly assigned to one of three groups and received endotoxin (S. typhi, 10 ng kg(-1) min(-1)) for 30 h. After 24 h the sheep were anesthetized (ketamine/midazolam), mechanically ventilated with oxygen, and received 0.1 ml kg(-1) oleic acid: oxy group (n=6), an infusion of Ringer's lactate was restricted to 1 ml kg(-1) h(-1); fluid/oxy group (n=6), a bolus of 10 ml kg(-1) Ringer's lactate plus 10 ml kg(-1) h(-1) was given; fluid/NO group (n=6), the sheep were treated as in the fluid/oxy group, except that they inhaled nitric oxide (20 ppm).


RESULTS
The extravascular lung water index was measured using thermodye dilution. Oleic acid increased extravascular lung water, impaired oxygenation, and reduced cardiac index at 26 h in all groups. After 30 h the extravascular lung water in the fluid/NO group was not higher than in the oxy group and significantly than in the fluid/oxy group. While cardiac index returned to the level of sepsis baseline in fluid/NO and fluid/oxy, it was reduced in the oxy group after 30 h. There were no significant differences in cardiac index between groups.


CONCLUSIONS
Inhaled nitric oxide may be an option for reducing edema formation secondary to fluid resuscitation in acute lung injury.
Stubbe
Henning D
HD
Klinik und Poliklinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum, 48149 Münster, Germany. hstubbe@uni-muenster.de
Westphal
Martin
M
Van Aken
Hugo
H
Hucklenbruch
Christoph
C
Lauer
Stefan
S
Jahn
Uli R
UR
Hinder
Frank
F
D000280:Administration, Inhalation; D000818:Animals; D015633:Extravascular Lung Water / Q000187:drug effects; D005260:Female; D005440:Fluid Therapy; D006439:Hemodynamics / Q000187:drug effects; D009569:Nitric Oxide / Q000008:administration & dosage*; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000188:drug therapy*; D011659:Pulmonary Gas Exchange / Q000187:drug effects; D011897:Random Allocation; D012128:Respiratory Distress Syndrome / Q000188:drug therapy*; D012151:Resuscitation / Q000379:methods; D012756:Sheep
D009569:Nitric Oxide