Acute myocardial infarction with normal coronary arteries during septic shock from Neisseria meningitidis |
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Authors: | G S Filippatos D Kardara E Sioras F Kardaras E Paramithiotou A Prekates C Roussos |
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Institution: | (1) 2nd Department of Cardiology, Evangelismos General Hospital, Athens, Greece, GR;(2) Department of Critical Care and Pulmonary Services, National and Kapodistrian University of Athens Medical School, Evangelismos Hospital, Athens, Greece, GR |
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Abstract: | Objective: To investigate a possible additive effect of combined nitric oxide (NO) and almitrine bismesylate (ALM) on pulmonary ventilation-perfusion (?·VA/?·Q) ratio.¶Design: Prospective, controlled animal study.¶Setting: Animal research facility of a university hospital.¶Interventions: Three conditions were studied in ten female pigs with experimental acute lung injury (ALI) induced by repeated lung lavage: 1) 10 ppm NO, 2) 10 ppm NO with 1 μg/kg per min ALM, 3) 1 μg/kg per min ALM. For each condition, gas exchange, hemodynamics and?·VA/?·Qdistributions were analyzed using the multiple inert gas elimination technique (MIGET).¶Measurement and results: With NO + ALM, arterial oxygen partial pressure (PaO2) increased from 63 ± 18 mmHg to 202 ± 97 mmHg while intrapulmonary shunt decreased from 50 ± 15 % to 26 ± 12 % and blood flow to regions with a normal?·VA/?·Qratio increased from 49 ± 16 % to 72 ± 15 %. These changes were significant when compared to untreated ALI (p < 0.05) and NO or ALM alone (p < 0.05), although improvements due to NO or ALM also reached statistical significance compared to ALI values (p < 0.05).¶Conclusions: We conclude that NO + ALM results in an additive improvement of pulmonary gas exchange in an experimental model of ALI by diverting additional blood flow from non-ventilated lung regions towards those with normal?·VA/?·Qrelationships. |
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Keywords: | Acute respiratory distress syndrome Nitric oxide Almitrine bismesylate Multiple inert gas elimination technique |
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