Article révisé par les pairs
| Résumé : | Numerous studies have shown that nitric oxide (NO) is implicated in the decreased responsiveness to adrenergic vasopressor in septic shock. In addition, NO affects mitochondrial respiration and plays a role in the development of organ dysfunction. However, NO has also some beneficial effects in septic shock, especially at the microcirculatory level. In this review, we discuss the concept of NO inhibition in septic shock. Two large studies on non-selective inhibitors of NO synthase were recently conducted in patients with septic shock. Both studies reported that L-NNMA restored vascular responsiveness to adrenergic vasopressors. However, some deleterious effects were also observed, with a decrease in cardiac output and oxygen delivery. Even though the phase II trial did not show any significant effect on outcome, phase III trial reported that mortality significantly increased in patients treated with L-NNMA. The exact mechanisms responsible for this increased mortality are not well understood but the decrease in tissue perfusion may have played a role. Actually, it is quite impossible to determine whether these deleterious effects were due to the compound (L-NNMA), its dosage, or to the whole concept of NO inhibition, whatever its mode of action. © 2005 Société de Réanimation de Langue Française. Publié par Elsevier SAS. Tous droits réservés. |
