title: Distant effects of nitric oxide inhalation in lavage-induced lung injury in anaesthetised pigs.
abstract: BACKGROUND
  Inhalation of nitric oxide (INO) exerts both local and distant effects. INO in healthy pigs causes down-regulation of endogenous nitric oxide (NO) production and vasoconstriction in lung regions not reached by INO, especially in hypoxic regions, which augments hypoxic pulmonary vasoconstriction. In contrast, in pigs with endotoxemia-induced lung injury, INO causes increased NO production in lung regions not reached by INO. The aim of this study was to investigate whether INO exerts distant effects in surfactant-depleted lungs.
  
  
  METHODS
  Twelve pigs were anaesthetised, and the left lower lobe (LLL) was separately ventilated. Lavage injury was induced in all lung regions, except the LLL. In six pigs, 40 ppm INO was given to the LLL (INO group), and the effects on endogenous NO production and blood flow in the lavage-injured lung regions were studied. Six pigs served as a control group. NO concentration in exhaled air (ENO), NO synthase (NOS) activity and cyclic guanosine monophosphate (cGMP) in lung tissue, and regional pulmonary blood flow were measured.
  
  
  RESULTS
  The calcium (Ca(2+) )-dependent NOS activity was lower (P < 0.05) in the lavage-injured lung regions in the INO group than in the control group. There were no measurable differences between the groups for Ca(2+) -independent NOS activity, cGMP, ENO, or regional pulmonary blood flow.
  
  
  CONCLUSIONS
  Regional INO did not increase endogenous NO production in lavage-injured lung regions not directly reached by INO, but instead down-regulated the constitutive calcium-dependent nitric oxide synthase activity, indicating that NO may inhibit its own synthesis.
authors.affiliation: Department of Anesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden. manja.nilsson@surgsci.uu.se
authors.forename: M C A
authors.initials: MC
authors.lastname: Nilsson
authors.forename: K
authors.initials: K
authors.lastname: Hambraeus-Jonzon
authors.forename: K
authors.initials: K
authors.lastname: Alving
authors.forename: P
authors.initials: P
authors.lastname: Wiklund
authors.forename: M
authors.initials: M
authors.lastname: Bergquist
authors.forename: F
authors.initials: F
authors.lastname: Fredén
mesh_terms: D055371:Acute Lung Injury / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D000280:Administration, Inhalation; D000758:Anesthesia; D000818:Animals; D001784:Blood Gas Analysis; D018893:Bronchoalveolar Lavage / Q000009:adverse effects*; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006152:Cyclic GMP / Q000378:metabolism; D019332:Endothelin-1 / Q000378:metabolism; D004731:Endotoxins; D006439:Hemodynamics / Q000502:physiology; D008168:Lung / Q000503:physiopathology; D009569:Nitric Oxide / Q000008:administration & dosage / Q000627:therapeutic use*; D019001:Nitric Oxide Synthase / Q000378:metabolism; D011652:Pulmonary Circulation / Q000187:drug effects / Q000502:physiology; D012121:Respiration, Artificial; D013552:Swine
chemical_list: D001993:Bronchodilator Agents; D019332:Endothelin-1; D004731:Endotoxins; D009569:Nitric Oxide; D019001:Nitric Oxide Synthase; D006152:Cyclic GMP