Kidney international. Supplement
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Nitric oxide (NO) is an effector molecule with multiple effects on various organ systems. The most prominent physiological actions of NO as a biological mediator include cGMP-dependent vasodilation and cytotoxicity against pathogens in the unspecific immune defense. Sepsis syndrome is a complex disease entity mostly caused by overwhelming bacterial infections. ⋯ However, their use is complicated by concomitant decreases in cardiac index and oxygen delivery. Conclusive data on mortality in animals and patients with sepsis-syndrome treated by NOS antagonists are not available. This article discusses current concepts concerning the L-arginine/NO system in the pathophysiology of and as a potential therapeutic target in septic shock.
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Critically ill patients with systemic inflammatory response syndrome (SIRS) and multi-organ failure are at great risk of nosocomial infections due to a reduced immune status. There is growing evidence from in vitro studies and animal models that the reduced immune response might be improved by the so-called immunomodulatory nutrition. Based on these studies there are now some commercially available enteral or parenteral solutions with immunomodulatory substrates, such as n-3 polyunsaturated fatty acids (PUFAs), arginine and nucleotides. ⋯ The increasing knowledge about the metabolic effects of these nutritions offers therapeutic potential for the future, and might reduce the mortality of critically ill patients from nosocomial infections. However, at present, studies are necessary to find the best time for beginning and duration of the feeding. In addition, the optimal dosage and composition of these pharmacologically active substances has to be investigated.