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Exhaled NO and plasma cGMP increase after endotoxin infusion in healthy volunteers

¹ Dept of Anaesthesiology and Intensive Care, Center for Surgical Sciences, Huddinge University Hospital, ² Dept of Physiology and Pharmacology and ³ Dept of Surgical Sciences, Section of Anaesthesiology and Intensive Care, Karolinska Hospital, and ⁴ Dept of Anaesthesiology and Intensive Care, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden

CORRESPONDENCE: A. Soop, K32 Dept of Anaesthesiology and Intensive Care, Huddinge University Hospital, 141 86, Stockholm, Sweden. Fax: 46 87795424. E-mail: anne.soop@anaesth.hs.sll.se

Keywords: endotoxin, exhaled, gut, human, nitric oxide, shock

Received: March 27, 2002
Accepted October 22, 2002

This study was supported by grants to A. Sollevi from the Swedish Medical Research Council, project numbers 7485 and project number 12586, and to E. Weitzberg from the Swedish Heart Lung Foundation.

Nitric oxide (NO) is believed to be involved in the pathophysiology of sepsis. This study evaluated the activity of the NO pathway in a human endotoxin model.

At baseline and after endotoxin, on-line measurements of exhaled NO (eNO) were made using a chemiluminescence technique with a single-breath method. NO-free air was inhaled prior to exhalation against a resistance. NO in orally and nasally exhaled air and in rectal gas was investigated. Plasma nitrite, nitrate, and guanosine 3', 5'-monophosphate (cGMP) and the events after diclophenac administration were also studied.

Endotoxin infusion resulted in tachycardia and fever. An early increase in oral eNO concentration was observed and oral eNO decreased after diclophenac administration. NO exhaled nasally, NO in rectum gas and nitrite/nitrate levels remained unchanged over the study period. cGMP increased after 4 h.

These findings suggest an early increase in nitric oxide production from the lungs, probably due to increased activity of the constitutive nitric oxide synthase upon endotoxin stimulation. In contrast, nitric oxide production in the upper airways, measured as nasally exhaled nitric oxide and nitric oxide in rectal gas, remained unchanged. Further studies will elucidate if exhaled nitric oxide is a valuable marker of sepsis-induced lung injury and if monitoring of treatment is possible.