Elevated Plasma Hemoglobin Levels Increase Nitric Oxide Consumption in Experimental and Clinical Acute Pulmonary Thromboembolism

dc.contributorUniversidade Estadual Paulista (UNESP)
dc.creatorSertorio, Jonas T.
dc.creatorNeto-Neves, Evandro M.
dc.creatorDias-Junior, Carlos A.
dc.creatorSousa-Santos, Ozelia
dc.creatorKiss, Tamas
dc.creatorMuehl, Diana
dc.creatorTanus-Santos, Jose E.
dc.date2014-12-03T13:10:52Z
dc.date2016-10-25T20:11:34Z
dc.date2014-12-03T13:10:52Z
dc.date2016-10-25T20:11:34Z
dc.date2013-07-01
dc.date.accessioned2017-04-06T06:24:05Z
dc.date.available2017-04-06T06:24:05Z
dc.identifierCritical Care Medicine. Philadelphia: Lippincott Williams & Wilkins, v. 41, n. 7, p. E118-E124, 2013.
dc.identifier0090-3493
dc.identifierhttp://hdl.handle.net/11449/112602
dc.identifierhttp://acervodigital.unesp.br/handle/11449/112602
dc.identifier10.1097/CCM.0b013e31827c0b43
dc.identifierWOS:000320579800002
dc.identifierhttp://dx.doi.org/10.1097/CCM.0b013e31827c0b43
dc.identifier.urihttp://repositorioslatinoamericanos.uchile.cl/handle/2250/923362
dc.descriptionObjectives: We examined whether experimental lung embolization with autologous blood clots or with the infusion of microspheres increase cell-free hemoglobin levels and nitric oxide consumption by plasma samples from anesthetized lambs. These parameters were also measured in patients with acute pulmonary thromboembolism at baseline conditions and after thrombolysis, and in healthy controls.Design: Controlled animal and clinical studies.Setting: University research laboratory and university hospital.Subjects: Sheep and humans.Interventions: Anesthetized lambs were embolized with intravenous injections of autologous blood clots or repeated injections of 300 m microspheres. Control animals received saline. Blood samples were drawn from patients with acute pulmonary thromboembolism at baseline conditions and after thrombolytic therapy with streptokinase or alteplase.Measurements and Main Results: Hemodynamic measurements were performed and plasma cell-free hemoglobin concentrations were measured. A nitric oxide consumption assay was used to measure nitric oxide consumption by plasma samples. Embolization with blood clots or microspheres increased mean pulmonary artery pressure from similar to 15 to similar to 40 mm Hg in lambs. Both plasma hemoglobin concentrations and nitric oxide consumption increased in proportion to the hemodynamic alterations and correlated significantly. Patients with acute pulmonary thromboembolism had higher plasma hemoglobin concentrations and nitric oxide consumption than healthy controls. Thrombolysis with streptokinase or alteplase further increased both parameters, which peaked 1-3 days after thrombolysis.Conclusions: Our results show consistent evidence indicating a new mechanism involving increased hemoglobin decompartmentalization and augmented nitric oxide consumption, possibly contributing to the hemodynamic derangement of acute pulmonary thromboembolism.
dc.descriptionFundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
dc.descriptionConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)
dc.descriptionCoordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
dc.languageeng
dc.publisherLippincott Williams & Wilkins
dc.relationCritical Care Medicine
dc.rightsinfo:eu-repo/semantics/closedAccess
dc.subjectacute pulmonary thromboembolism
dc.subjectconsumption
dc.subjecthemoglobin
dc.subjecthemolysis
dc.subjectnitric oxide
dc.subjectpulmonary embolism
dc.subjectpulmonary hypertension
dc.titleElevated Plasma Hemoglobin Levels Increase Nitric Oxide Consumption in Experimental and Clinical Acute Pulmonary Thromboembolism
dc.typeOtro


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