Is nitroglycerine ready for prime time in septic shock management?

Abstract

Microcirculatory shunting plays a central role in the pathophysiology of septic shock. It may explain the normal or supranormal values of central venous oxygen saturation that are commonly seen in septic patients. Large amounts of nitric oxide (NO) are produced during sepsis, partly explaining hypotension and reduced vascular reactivity to vasopressors. However, NO plays a central role in maintaining microcirculation homeostasis. Moreover inhibiting NO production with NO synthase inhibitors appears deleterious. A growing body of evidence suggests a beneficial effect of NO donors for treating microcirculation abnormalities and even for reducing mortality. To date, more and more intensive care units are using nitroglycerin in severe sepsis, although a study assessing its efficiency remains still required before any definitive conclusion.