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September 11, 1996

Nitric Oxide and Sepsis-Reply

Author Affiliations

Washington University St Louis, Mo
National Institutes of Health Bethesda, Md

JAMA. 1996;276(10):781-782. doi:10.1001/jama.1996.03540100025017

In Reply.  —The criticisms of Drs Szabo and Kilbourn are directed at studies indicating that NOS inhibitors are potentially harmful. They suggest that these investigations should be disregarded on the basis of various hypotheses: the dose of endotoxin was too high; the wrong sepsis model was used; the wrong NOS inhibitor was chosen; the NOS inhibitor was not administered at the right time or in the correct manner; the adverse effects were disease related and not due to NOS inhibition; or, finally, other agents were not given to reverse the untoward effects of NOS inhibition.Like the many other endogenous mediators of septic shock, nitric oxide has potential both to protect and to harm the host. Our review describes this dual nature and reflects our belief in scientific discourse founded on consideration of all results. Historically, such an approach has proven to be effective in incorporating new agents into clinical practice and