Abstract
Septic shock is characterized by fever, metabolic abnormalities, cardiovascular instability and multiple organ failure. The predominant physiological change that occurs in all septic shock patients is the loss of vascular tone. This in turn leads to hypotension and alterations in microvascular blood flow resulting in major organ dysfunction. It is important that alternatives be found to currently available vasopressor therapy for septic shock. Recent studies [1–3] have shown that doses of norepinephrine needed to achieve recommended physiological endpoints lead to increased mortality presumably through non-specific excessive vasoconstriction of critical vascular beds resulting in secondary organ failure.
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Shoemaker WC, Appel PL, Kram HB, Waxman K, Tai-Shion L (1988) Prospective trial of supra-normal values of survivors as therapeutic goals in high-risk surgical patients. Chest 94: 1176–1186
Boyd O, Grounds R, Bennett E. (1993) A randomized clinical trial of the effect of deliberate periopative increase of oxygen delivery on mortality in high risk surgical patients. J Am Med Assoc 270: 2699–2707
Hayes M, Timmins A, Yau E (1994) Elevation of systemic oxygen delivery in the treatment of critically ill patients. N Engl J Med 330: 1717–1722.
Furchgott R, Zawadzki J (1980) The Obligatory role of endothelial cells in the relaxation of arterial smooth muscle by Acetylcholine. Nature 288: 373–376
Palmer R, Ferrige A, Moncada S (1987) Nitric oxide release accounts for the biological activity of endothelium-derived relaxing factor. Nature 327: 524–526
Stuehr D, Griffith OW (1991) Mammalian nitric oxide synthases. Adv Enzymol 65: 287–346
Kilbourn RG, Belloni P (1990) Endothelial cell production of nitrogen oxides in response to interferon gamma in combination with tumor necrosis factor, interleukin-1, or endotoxin. J Natl Cancer Inst 82: 772–776
Ochoa J, Udekwu A, Billiar T (1991) Nitrogen oxide levels in patients after trauma and during sepsis. Ann Surg 214: 621–626
Ochoa J, Curti B, Peitzman A, et al (1992) Increased circulating nitrogen oxides after human tumor immunotherapy correlate with toxic hemodynamic changes. J Natl Cancer Inst 84: 864–867
Hibbs J, Westenfelder C, Taintor R, et al (1992) Evidence for cytokine-inducible nitric oxide synthesis from L-arginine in patients receiving interleukin-2 therapy. J Clin Invest 89: 867–877
Lee R, Lotze M, Skibber J, et al (1989) Cardiorespiratory effects of immunotherapy with interleukin-2. J Clin Oncol 7: 7–20
Ognibene F, Rosenberg S, Skibber J, Shelhamer J, Lotze M, Parrillo J (1986) Interleukin-2 hemo-dynamics mimic septic shock. Clin Res 34: 413A (Abst)
Rosenberg SA, Lotze MT, Yang JC, et al (1989) Experience with the use of high-dose interleukin2 in the treatment of 652 cancer patients. Ann Surg, 210: 474–484.
Calandra T, Baumgartner J, Grau G, et al (1990) Prognostic values of tumor necrosis factor/ cachectin, interleukin-1, interferon-a, and interferon-y in the serum of patients with septic shock. J Infect Dis 161: 982–987
Boccoli G, Masciulli E, Ruggeri E, et al (1990) Adoptive immunotherapy of human cancer: The cytokine cascade and monocyte activation following high-dose interleukin-2 bolus treatment. Cancer Res 50: 5795–5800
Lorente JA, Landin LL, De Pablo R, Renes E, Liste D (1993) L-arginine pathway in the sepsis syndrome. Crit Care Med. 21: 1287–1295
Sharma V, Ranney T (1978) The dissociation of NO from nitrosyhemoglobin. J Biol Chem 18: 6467–6472
Sharma V, Traylor T, Gardiner R, Mizukami H (1987) Reaction of nitric oxide with heme proteins and model compounds of hemoglobin. Biochem 26: 3837–3843
Addison A, Stephanos J (1986) Nitrosyliron (III) hemoglobin: Autoreduction and spectroscopy. Biochem 25: 4104–4113
Ignarro LJ, Porenta G, Brunken R, Tillisch J (1991) Pharmacology of endothelium-derived nitric oxide and nitrovasodilators. West J Med 154: 51–62
Kosaka H, Watanabe M, Yoshihara H (1992) Detection of nitric oxide production in lipopolysaccharide-treated rats by ESR using carbon monoxide hemoglobin. Biochem Biophys Res Comm 184: 1119–1124
Westenberger U, Thanner S, Ruf H (1990) Formation of free radicals and nitric oxide derivative of hemoglobin in rats during septic shock. Free Rad, Res Comm 11: 167–178
Jia L, Bonaventura C, Bonaventura J, Stamler J (1996) S-nitrosohemoglobin: A dynamic activity of blood involved in vascular control. Nature 380: 221–237
Fleming I, Gray G, Julou-Schaeffer G, Parratt J, Schott C, Stoclet J (1990) Impaired vascular reactivity in the rat following endotoxin treatment can be endothelium independent, yet involves the L-arginine pathway. J Physiol 423: 18 P
Gray G, Julou-Schaeffer G, Oury K, Fleming I, Parratt J, Stoclet J (1990) An L-arginine derived factor mediates endotoxin-induced vascular hyposensitivity to calcium. Eur J Pharmacol 191: 89–92
Julou-Schaeffer G, Gray G, Fleming I, Schott C, Parratt J, Stoclet J (1990) Loss of vascular responsiveness induced by endotoxin involves L-arginine pathway. Am J Physiol 259: H1038 - H1043
Petros A, Bennett D, Valiance P (1991) Effects of nitric oxide synthase inhibitors on hypotension in patients with septic shock. Lancet 338: 1557–1558
Kilbourn RG, Joly G, Cashon B, DeAngelo J, Bonaventura J (1994) Cell-free hemoglobin reverses the endotoxin-mediated hyporesponsivity of rat aortic rings to a-adrenergic agents. Biochem Biophys Research Comm 199: 155–162
Hibbs J, Taintor R, Vavrin Z (1987) Macrophage cytotoxicity: Role for L-arginine deiminase and imino nitrogen oxidation to nitrite. Science 235: 473–476
Kilbourn R, Gross S, Levi R, Lodato R (1990) Tumor necrosis factor-induced hypotension is caused by endothelium-derived relaxing factor. Proc Am Assoc Cancer Res 31: 298 (Abst)
Kilbourn R, Owen-Schaub L, Griffith O, Logothetis C (1992) Interleukin-2 mediated hypotension in dogs is reversed by N“-monomethyl-L-arginine (NMA), an inhibitor of nitric oxide (NO) formation. Am Assoc Cancer Res, 33: 328 (Abst)
Kilbourn RG, Jubran A, Gross SS, et al (1990) Reversal of endotoxin-mediated shock by NGmethyl-L-arginine, an inhibitor of nitric oxide synthesis. Biochem Biophys Res Commun 172: 1132–1138
Bone H, Traber L, Schenarts P, Spauding T, Traber D (1995) Hemodynamic effects of pyridoxylated hemoglobin polyoxyethylene conjungate (PHP) in conscious sheep during septic shock. Anesthesiology 83: A232 (Abst)
Malcolm D, Hamilton I, Schultz S, Cole F, Burhop K (1994) Characterization of the hemodynamic response to intravenous diaspirin cross-linked hemoglobin solution in rats. Artif Cells Blood Sustit Immobil Biotechnol 22: 91–107
Iwashita V (1995) Hemoglobin conjurgated with polyoxyethylene. In artificial red cells. In: Tsuchida E (ed) John Wiley and Sons, pp 151–176
Kida Y, Iwata S, Gyoutoku Y, Yamakawa T, Nishi K (1991) Vascular responsiveness to various vasoactive substances after exchange transfusion with pyridoxylated hemoglobin polyoxyethylene conjurgate (PHP) solution in anesthetized rats. Artif Organs 15: 5–14
Malchesky P, Takahashi T, Iwaski K, Harasaki H, Nose Y (1990) Conjurgated human hemoglobin as a physiological oxygen carrier-pyridoxylated hemoglobin polyoxyethylene conjugate (PHP). Artif. Organs 13: 442–450
Yabuki A, Yamaji K, Ohki H, Iwashita Y (1990) Characterization of pyridoxylated hemoglobin polyoxyethylene conjurgate as a physiological oxygen carrier. Transfusion 30: 516–520
Kilbourn R, Fonseca G, Griffith O, et al (1995) NG-methyl-L-arginine, an inhibitor of nitric oxide synthase that reverses interleukin-2 induced hypotension. Crit Care Med 23: 1018–1024
Rhea G, Bodenham A, Mallick A, Prebelski R, Daily E (1996) Vasopressor effects of diaspirin cross-linked hemoglobin in critically ill patients. Crit Care Med 26: A64 (Abst)
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Kilbourn, R.G., DeAngelo, J., Bonaventura, J. (1997). Clinical Effects of Cell-Free Hemoglobin, a Scavenger of Nitric Oxide, in Septic Shock. In: Vincent, JL. (eds) Yearbook of Intensive Care and Emergency Medicine 1997. Yearbook of Intensive Care and Emergency Medicine, vol 1997. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-13450-4_22
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DOI: https://doi.org/10.1007/978-3-662-13450-4_22
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