Am. J. Respir. Crit. Care Med., Volume 161, Number 6, June 2000, 1781-1785

Effects of Nitric Oxide in Septic Shock

JEAN-LOUIS VINCENT, HAIBO ZHANG, CSABA SZABO, and JEAN-CHARLES PREISER

Department of Intensive Care, Erasme University Hospital, Free University of Brussels, Brussels, Belgium; Division of Respiratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; and Division of Critical Care, Children's Hospital Medical Center, Cincinatti, Ohio

Nitric oxide (NO) is believed to play a key role in the pathogenesis of septic shock, although many aspects of NO's involvement remain poorly defined. Recent years have seen advances in our understanding of the production and effects of NO, but much of the work has been done in animal models and may not be directly relevant to the clinical situation. Differences between species and models can account for many of the apparently conflicting results obtained. Nevertheless, NO-directed strategies have been developed and tested clinically. However, NO can have both beneficial and detrimental effects on many organ systems in sepsis and attempts to nonselectively block all its actions may therefore not yield positive results on outcome. Further exploration and precision of the role of NO and development of techniques to assess the NO balance in individual patients is necessary before further progress can be made in this field.

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