Clinical efficacy of nitroglycerin in patients with septic shock with ARDS

Objective To evaluate the clinical efficacy of nitroglycerin in patients with septic shock with ARDS, and explore its possible mechanism. Methods From January 2013 to January 2014, patients with septic shock with ARDS were included in the study in the department of critical care medicine in our hospital. Patients who met the criteria were randomly divided into the control group and the nitroglycerin group. The standard treatment was given in control group, and nitroglycerin 0.5-1.0mg/h was given in nitroglycerin group on basis of standard treatment. Monitoring indexes were recorded at 0, 6, 24 and 72h, including general condition, APACHE Ⅱ score, hemodynamic indexes (HR, MAP, CVP, CI, SVRI, PAWP, PAP, Lac), volume of fluid resuscitation, quantity of vasopressor drugs, ventilator condition (PH, PO2, PCO2, RR, PEEP, VT, FiO2, oxygenation index, airway resistance, lung compliance), mechanical ventilation time, ICU stay time, hospital follow-up, 28-day follow-up, immune index (CD4+/CD8+), inflammatory markers (CRP, PCT, IL-6, WBC). Results Forty-three patients were included in this study, with 21 in control group and 22 in nitroglycerin group. At 24 and 72h after the treatment, APACHEⅡ score, heart rate, pulmonary artery pressure (PAP), lactic acid and dopamine, norepinephrine, respiratory rate (RR), inspired oxygen concentration (FiO2), airway resistance, C reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), white blood cell count (WBC) significantly decreased as compared with those at 0 and 6 h, and these parameters in nitroglycerin group were lower than these in the control group at the 72h (P<0.05); at the same time, those indexes such as peripheral vascular resistance index (SVRI), pH value, arterial partial pressure of oxygen (PaO2), tidal volume (VT), lung compliance, oxygenation index, CD4+/CD8+ more significantly increased in the treatment group at 24 and 72h than those at 0 and 6h, especially at 72h, and these values were significantly higher than that of control group (P<0.05). Time of mechanical ventilation, ICU stay and hospital stay in nitroglycerin group was respectively lower than those of the control group (P<0.05); the hospital mortality and 28-day mortality rate in nitroglycerin group were significantly lower than that of control group (P