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April 17, 1996

Nitric Oxide and Septic Shock

JAMA. 1996;275(15):1192-1196. doi:10.1001/jama.1996.03530390058035


Case 1  A 23-year-old woman presented with a 2-week history of bruising and fever. She was diagnosed as having acute myelogenous leukemia. Three days after beginning chemotherapy, she became disoriented and hypotensive. Her platelet count was 60×109/L, and her white blood cell count was 1.0×109/L, with an absolute neutrophil count of 0.48×109/L. She was resuscitated with 3 L of saline and she was given dopamine at 5 μg·kg-1·min-1 and broad-spectrum antibiotics. Her chest radiograph revealed diffuse interstitial-alveolar infiltrates. She required mechanical ventilation for progressive hypoxemia. Pulmonary and radial arterial catheters were inserted and the following hemodynamic parameters were obtained: blood pressure, 90/35 mm Hg; mean arterial pressure (MAP), 53 mm Hg; heart rate, 124 beats per minute; cardiac index, 7.8 L·min-1·m-2; central venous pressure (CVP), 12 mm Hg; pulmonary artery pressure, 42/28 mm Hg; pulmonary capillary