Organ dysfunction among piglets treated with inhaled nitric oxide and intravenous hydrocortisone during prolonged endotoxin infusion.
OBJECTIVE
It has previously been shown that a combination of inhaled nitric oxide (iNO) and intravenous (IV) steroid attenuates endotoxin-induced organ damage in a 6-hour porcine endotoxemia model. We aimed to further explore these effects in a 30-hour model with attention to clinically important variables.


METHODS
Randomized controlled trial.


METHODS
University animal laboratory.


METHODS
Domestic piglets (n = 30).


METHODS
Animals were randomized into 5 groups (n = 6 each): 1) Controls, 2) LPS-only (endotoxin/lipopolysaccharide (LPS) infusion), 3) LPS + iNO, 4) LPS + IV steroid, 5) LPS + iNO + IV steroid.


RESULTS
Exposure to LPS temporarily increased pulmonary artery mean pressure and impeded renal function with elevated serum creatinine and acidosis compared to a control group over the 30-hour study period. Double treatment with both iNO and IV steroid tended to blunt the deterioration in renal function, although the only significant effect was on Base Excess (p = 0.045). None of the LPS + iNO + IV steroid treated animals died during the study period, whereas one animal died in each of the other LPS-infused groups.


CONCLUSIONS
This study suggests that combined early therapy with iNO and IV steroid is associated with partial protection of kidney function after 30 hours of experimental LPS infusion.
Department of Anesthesia and Intensive Care, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
Sofie Paues
SP
Göranson
Department of Anesthesiology and Intensive Therapy, Wroclaw University of Medicine, Wroclaw, Poland.
Waldemar
W
Goździk
Department of Anesthesia and Intensive Care, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
Piotr
P
Harbut
Department of Anesthesia and Intensive Care, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
Stanisław
S
Ryniak
Department of Anesthesiology and Intensive Therapy, Wroclaw University of Medicine, Wroclaw, Poland.
Stanisław
S
Zielinski
Department of Anesthesia and Intensive Care, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
Caroline Gillis
CG
Haegerstrand
Department of Anesthesiology and Intensive Therapy, Wroclaw University of Medicine, Wroclaw, Poland.
Andrzej
A
Kübler
Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
Göran
G
Hedenstierna
Department of Anesthesia and Intensive Care, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
Claes
C
Frostell
Department of Anesthesia and Intensive Care, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
Johanna
J
Albert
D000280:Administration, Inhalation; D000818:Animals; D003404:Creatinine / Q000097:blood; D004195:Disease Models, Animal; D019446:Endotoxemia / Q000097:blood / Q000139:chemically induced / Q000503:physiopathology* / Q000517:prevention & control; D006439:Hemodynamics / Q000187:drug effects; D006854:Hydrocortisone / Q000494:pharmacology*; D007275:Injections, Intravenous; D007668:Kidney / Q000187:drug effects / Q000378:metabolism / Q000503:physiopathology*; D007677:Kidney Function Tests; D008070:Lipopolysaccharides; D009569:Nitric Oxide / Q000494:pharmacology*; D020011:Protective Agents / Q000494:pharmacology*; D013552:Swine; D013997:Time Factors
D008070:Lipopolysaccharides; D020011:Protective Agents; D009569:Nitric Oxide; D003404:Creatinine; D006854:Hydrocortisone