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September 11, 1996

Nitric Oxide and Sepsis

JAMA. 1996;276(10):781. doi:10.1001/jama.1996.03540100025016

To the Editor.  —Drs Cobb and Danner1 describe 2 case reports and provide an overview of the literature that is presented in an unbalanced perspective and is inconsistent with the available knowledge in the field. Although the review quotes many references, much of the basis for the conclusions are from 2 experiments, both originating from the authors' own laboratory. As a result, the authors tend to look at the field as a whole in the perspective of these 2 reports, which have major flaws.First, the dose of endotoxin used to induce lethality is 400 times greater than the dose that causes moderate to severe hypotension in dogs. Indeed, the same group worked diligently for years to develop a sepsis model using an intraperitoneal septic clot that more closely simulates the human cardiovascular response than the endotoxin bolus model. Interestingly, when they finally used the clot model to study