Systemic organoprotection with inhaled nitric oxide (literature review)

Abstract

Sufficient levels of nitric oxide (NO) ensure adequate blood flow to all organs and tissues. Despite the contradictory data on the role of endogenous NO as an organоprotector, NO insufflation is a promising direction, which is supported by evidence of modeling the protective effect on the myocardium, kidneys, and liver with exogenous NO in experimental and clinical studies. The largest number of studies have been conducted on models of ischemia-reperfusion injury in cardiovascular surgery. There are very few studies in abdominal and other non-cardiac surgery and they are mostly experimental. This review describes possible ways of implementing the organоprotective effect of NO, however, the exact mechanism remains not fully understood. One of the main links in the development of abdominal organ injury is intra-abdominal hypertension (IAH), which always accompanies laparoscopic surgeries and can last up to several hours. IAH causes ischemia of the kidneys and gastrointestinal mucosa with possible subsequent development of organ dysfunction. The degree of damage will depend not only on the duration of IAH but also on the patient’s premorbid background. The prognosis will be especially aggravated by the presence of atherosclerotic vascular lesions, which creates a preoperative background for hypoperfusion of visceral organs, which, due to the characteristics of vascularization, anatomical structure, and functioning, are very sensitive to the slightest disturbances in perfusion pressure and to the systemic inflammatory reaction, which will subsequently lead to an increase in vascular permeability, the formation of transcapillary leakage and interstitial edema, which is the beginning of organ dysfunction. Dysregulation of the mechanisms involved in NO production may be a link in the pathogenesis of the development of organ’s dysfunction, so maintaining adequate NO levels may be a target for therapy.

Keywords

• nitric oxide
• ischemia
• reperfusion
• organoprotection
• abdominal surgery