1
|
Burra V, Sunil PK, Praveen NB, Nagaraja PS, Singh NG, Manjunatha N, Basappanavar VS. Role of urinary PO 2 analysis during conventional versus conventional and modified ultrafiltration techniques in adult cardiac surgery. Ann Card Anaesth 2021; 23:43-47. [PMID: 31929246 PMCID: PMC7034213 DOI: 10.4103/aca.aca_2_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Medullary hypoxia is the initial critical event for kidney injury during cardiopulmonary bypass, and therefore urinary PO2 with its potential of detecting medullary oxygenation for its management. Therefore, we tested the role of urinary PO2 in predicting kidney injury in those undergoing conventional versus combined (conventional and modified) ultrafiltration during cardiac surgery in adults. Methodology: We prospectively evaluated 32 adults between 18 and 65 years of age undergoing elective on-pump cardiac surgery with ejection fraction >35% by conventional (group C) versus combined ultrafiltration (group CM). Urine samples were analyzed for PO2 after induction, 30 min, 3 h, and 6 h post filtration along with blood urea and serum creatinine after induction, at 6 h, 24 h, and 48 h post filtration. Demographic variables, cardiopulmonary bypass duration, flow rates, inotropic score, ventilation duration, diuretic use, and intensive care unit (ICU) stay were assessed between two groups. Results: Both the groups (16 in each group) had comparable urinary PO2 after induction (P = 0.387) with significant decrease in group C at 30 min, 3 h, and 6 h post filtration (P < 0.05). There was a statistically significant increase in serum creatinine (mg/dL) at 48 h in group C compared with group CM (1.57 vs. 1.25, respectively; P ≤ 0.05). There was an increased diuretic usage and length of ICU stay in group C. Conclusion: Combined ultrafiltration technique had renoprotective effect in cardiac surgery analyzed by urinary PO2 levels.
Collapse
Affiliation(s)
- Vijitha Burra
- Department of Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar, Bengaluru, Karnataka, India
| | - P K Sunil
- Department of Cardiovascular and Thoracic Surgery, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar, Bengaluru, Karnataka, India
| | - N B Praveen
- Department of Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar, Bengaluru, Karnataka, India
| | - P S Nagaraja
- Department of Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar, Bengaluru, Karnataka, India
| | - Naveen G Singh
- Department of Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar, Bengaluru, Karnataka, India
| | - N Manjunatha
- Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jayanagar, Bengaluru, Karnataka, India
| | | |
Collapse
|
2
|
Ames WA. Pro: The Value of Modified Ultrafiltration in Children After Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth 2019; 33:866-869. [DOI: 10.1053/j.jvca.2018.10.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Indexed: 11/11/2022]
|
3
|
José Curi-Curi P, Aguilar Alanis E, Calderón- Colmenero J, Luis Cervantes-Salazar J, Reyes Pavón R, Ramírez-Marroquín S. Impact of Modified Ultrafiltration in Congenital Heart Disease Patients Treated with Cardiopulmonary Bypass. CONGENIT HEART DIS 2018. [DOI: 10.5772/intechopen.80599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
4
|
Thapmongkol S, Masaratana P, Subtaweesin T, Sayasathid J, Thatsakorn K, Namchaisiri J. The effects of modified ultrafiltration on clinical outcomes of adult and pediatric cardiac surgery. ASIAN BIOMED 2017. [DOI: 10.5372/1905-7415.0905.429] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background
Cardiopulmonary bypass (CPB) can contribute to the development of an inflammatory response and postsurgical morbidity. Conventional ultrafiltration and modified ultrafiltration (MUF) can mitigate the adverse effects of CPB by removing free water and inflammatory mediators, at least in part.
Objectives
To evaluate evidence for the effects of MUF on clinical outcomes of cardiac surgery in pediatric and adult patients.
Methods
A literature review of MEDLINE-indexed articles published between 1990 and June 2014 was conducted on PubMed. A search on the CTS.net website and the Cochrane Central Register of Controlled Trials was also performed with relevant keywords. The search was limited to English language articles and human studies.
Results
Our primary search identified 84 potential articles, of which 55 articles were relevant to conventional ultrafiltration, modified ultrafiltration, ultrafiltration, cardiopulmonary bypass, extracorporeal circulation, pediatric and adult cardiac surgery. There were 3 meta-analyses, 7 review literatures, 21 randomized controlled trials. The remainder consisted of 18 controlled and 6 observational studies. MUF has been beneficial effects on postoperative bleeding, chest drainage, transfusion requirement, and improvement cardiac function, but effects in adult cardiac surgery inconclusive because data was relatively limited.
Conclusions
MUF may improve post-CPB hemodynamic activity and cardiac function in pediatric cardiac surgery. By contrast, the clinical trials in adults are limited mostly by small sample sizes that preclude an adequately powered assessment of clinically relevant outcomes. The available data are conflicting and several studies show no differential outcomes. Further studies are required to identify patients who will most likely benefit from ultrafiltration and to establish standard protocols.
Collapse
Affiliation(s)
- Siraphop Thapmongkol
- Division of Cardiothoracic Surgery , Department of Surgery , Faculty of Medicine , Naresuan University Hospital , Naresuan University , Phitsanulok 65000 , Thailand
| | - Patarabutr Masaratana
- Department of Biochemistry , Faculty of Medicine , Siriraj Hospital , Bangkok 10700 , Thailand
| | - Thaworn Subtaweesin
- Division of Cardiothoracic Surgery , Department of Surgery , Faculty of Medicine , Siriraj Hospital , Mahidol University , Bangkok 10700 , Thailand
| | - Jarun Sayasathid
- Division of Cardiothoracic Surgery , Department of Surgery , Faculty of Medicine , Naresuan University Hospital , Naresuan University , Phitsanulok 65000 , Thailand
| | - Kanthachat Thatsakorn
- Division of Cardiothoracic Surgery , Department of Surgery , Faculty of Medicine , Naresuan University Hospital , Naresuan University , Phitsanulok 65000 , Thailand
| | - Jule Namchaisiri
- Division of Cardiovascular and Thoracic Surgery , Department of Surgery , King Chulalongkorn Memorial Hospital , Chulalongkorn University , Bangkok 10330 , Thailand
| |
Collapse
|
5
|
Curi-Curi PJ, Springall del Villar MR, Gómez-García L, González Vergara B, Calderón-Colmenero J, Ramírez-Marroquín S, Cervantes-Salazar JL. Impacto intraoperatorio de la ultrafiltración modificada en pacientes pediátricos sometidos a cirugía cardíaca con circulación extracorpórea. CIRUGIA CARDIOVASCULAR 2016. [DOI: 10.1016/j.circv.2016.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
6
|
Raja SG, Yousufuddin S, Rasool F, Nubi A, Danton M, Pollock J. Impact of Modified Ultrafiltration on Morbidity after Pediatric Cardiac Surgery. Asian Cardiovasc Thorac Ann 2016; 14:341-50. [PMID: 16868113 DOI: 10.1177/021849230601400417] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cardiopulmonary bypass is a double-edged sword. Without it, corrective cardiac surgery would not be possible in the majority of children with congenital heart disease. However, much of the perioperative morbidity that occurs after cardiac surgery can be attributed to a large extent to pathophysiologic processes engendered by extracorporeal circulation. One of the challenges that has confronted pediatric cardiac surgeons has been to minimize the consequences of cardiopulmonary bypass. Ultrafiltration is a strategy that has been used for many years in an effort to attenuate the effects of hemodilution that occur when small children undergo surgery with cardiopulmonary bypass. Over the past several years, a modified technique of ultrafiltration, commonly known as modified ultrafiltration, has been used with increasing enthusiasm. Multiple studies have been undertaken to assess the effects of modified ultrafiltration on organ function and postoperative morbidity following repair of congenital heart defects. This review attempts to evaluate current available scientific evidence on the impact of modified ultrafiltration on organ function and morbidity after pediatric cardiac surgery.
Collapse
Affiliation(s)
- Shahzad G Raja
- Department of Cardiac Surgery, Royal Hospital for Sick Children, Yorkhill NHS Trust, Dalnair Street, Glasgow G3 8SJ, United Kingdom.
| | | | | | | | | | | |
Collapse
|
7
|
Ziyaeifard M, Alizadehasl A, Massoumi G. Modified ultrafiltration during cardiopulmonary bypass and postoperative course of pediatric cardiac surgery. Res Cardiovasc Med 2014; 3:e17830. [PMID: 25478538 PMCID: PMC4253790 DOI: 10.5812/cardiovascmed.17830] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Revised: 02/18/2014] [Accepted: 03/10/2014] [Indexed: 12/16/2022] Open
Abstract
Context: The use of cardiopulmonary bypass (CPB) provokes the inflammatory responses associated with ischemic/reperfusion injury, hemodilution and other agents. Exposure of blood cells to the bypass circuit surface starts a systemic inflammatory reaction that may causes post-CPB organ dysfunction, particularly in lungs, heart and brain. Evidence Acquisition: We investigated in the MEDLINE, PUBMED, and EMBASE databases and Google scholar for every available article in peer reviewed journals between 1987 and 2013, for related subjects to CPB with conventional or modified ultrafiltration (MUF) in pediatrics cardiac surgery patients. Results: MUF following separation from extracorporeal circulation (ECC) provides well known advantages in children with improvements in the hemodynamic, pulmonary, coagulation and other organs functions. Decrease in blood transfusion, reduction of total body water, and blood loss after surgery, are additional benefits of MUF. Conclusions: Consequently, MUF has been associated with attenuation of morbidity after pediatric cardiac surgery. In this review, we tried to evaluate the current evidence about MUF on the organ performance and its effect on post-CPB morbidity in pediatric patients.
Collapse
Affiliation(s)
- Mohsen Ziyaeifard
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Azin Alizadehasl
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Azin Alizadehasl, Cardiology Department, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, Niayesh Blvd, Tehran, IR Iran. Tel: +98-2123922190, Fax: +98-2122663293, E-mail:
| | - Gholamreza Massoumi
- Anesthesiology Department, Isfahan University of Medical Sciences, Isfahan, IR Iran
| |
Collapse
|
8
|
Williams GD, Ramamoorthy C, Chu L, Hammer GB, Kamra K, Boltz MG, Pentcheva K, McCarthy JP, Reddy VM. Modified and conventional ultrafiltration during pediatric cardiac surgery: Clinical outcomes compared. J Thorac Cardiovasc Surg 2006; 132:1291-8. [PMID: 17140945 DOI: 10.1016/j.jtcvs.2006.05.059] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2006] [Revised: 05/03/2006] [Accepted: 05/12/2006] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This prospective study compared clinical outcomes after heart surgery between three groups of infants with congenital heart disease. One group received dilutional conventional ultrafiltration (group D), another received modified ultrafiltration (group M), and a third group received both dilutional conventional and modified ultrafiltration (group B). We hypothesized that group B patients would have the best clinical outcome. METHODS Children younger than 1 year undergoing heart surgery for biventricular repair by the same surgeon were randomly allocated to one of the three study groups. Patient management was standardized, and intensive care staff were blinded to group allocation. Primary outcome measure was duration of postoperative mechanical ventilation. Other outcome measures recorded included total blood products transfused, duration of chest tube in situ, chest tube output, and stays in intensive care and in the hospital. RESULTS Sixty infants completed study protocol. Mean age and weight were as follows: group D (n = 19), 61 days, 4.3 kg; group M (n = 20), 64 days, 4.5 kg; and group B (n = 21), 86 days, 4.4 kg. Preoperative and intraoperative characteristics were similar between groups. Ultrafiltrate volumes obtained were 196 +/- 93 mL/kg in group D, 105 +/- 33 mL/kg in group M, and 261 +/- 113 mL/kg in group B. There were no significant differences between groups for any outcome variable. Technical difficulties prevented completion of modified ultrafiltration in 2 of 41 infants. CONCLUSION There was no clinical advantage in combining conventional and modified ultrafiltration. Because clinical outcomes were similar across groups, relative risks of the ultrafiltration strategies may influence choice.
Collapse
Affiliation(s)
- Glyn D Williams
- Department of Anesthesia, Stanford University School of Medicine, Stanford, Calif 94305-5640, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Rodriguez RA, Ruel M, Broecker L, Cornel G. High Flow Rates During Modified Ultrafiltration Decrease Cerebral Blood Flow Velocity and Venous Oxygen Saturation in Infants. Ann Thorac Surg 2005; 80:22-8. [PMID: 15975333 DOI: 10.1016/j.athoracsur.2005.01.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2004] [Revised: 01/06/2005] [Accepted: 01/10/2005] [Indexed: 11/15/2022]
Abstract
BACKGROUND The intracranial hemodynamic effects of modified ultrafiltration in children are unknown. We investigated the effects of different blood flow rates during modified ultrafiltration on the cerebral hemodynamics of children with weights above and below 10 kg. METHODS Thirty-one children (weights: < or = 10 kg, n = 21; > 10 kg, n = 10) undergoing cardiopulmonary bypass were studied. Middle-cerebral artery blood flow velocities and cerebral mixed venous oxygen saturations were measured before, five minutes from the beginning, and at the end of ultrafiltration. Patients were classified according to their blood flow rates during ultrafiltration in three groups: high (> or = 20 mL/kg/min), moderate (10-19 mL/kg/min), and low flow rates (< 10 mL/kg/min). RESULTS During modified ultrafiltration, blood pressures and hematocrit increased (p < 0.001), but cerebral blood flow velocities and mixed venous oxygen saturations decreased (p < 0.001). A significant correlation was found between blood flow rates of ultrafiltration and the decline in mean cerebral blood flow velocity (r = - 0.48; p = 0.005) and cerebral oxygen saturation (r = - 0.49; p = 0.005) or hematocrit increase (r = 0.59; p = 0.001). Infants exposed to high flow rates had greater reduction of cerebral blood flow velocity and regional mixed venous saturation and higher hematocrit at the end of ultrafiltration compared with those subjected to moderate and low flow rates (p < 0.04). No significant difference was found between moderate and low flow groups. The flow rate of ultrafiltration was the only independent predictor of the changes in cerebral mixed venous oxygen saturation (p = 0.033). CONCLUSIONS High blood flow rates through the ultrafilter during modified ultrafiltration transiently decrease the cerebral circulation in young infants compared with lower blood flow rates. These effects may be related to an increased diastolic runoff from the aorta into the ultrafiltration circuit that leads to a "stealing" effect from the intracranial circulation, which may be important in infants with dysfunctional cerebral autoregulation.
Collapse
|
10
|
Abstract
Hemofiltration used in conjunction with cardiac surgery and cardiopulmonary bypass (CPB) was first reported in 1976. Since then, the technology has been routinely used in this context. This review attempts to restate the basic principles governing hemofiltration, the strategies or timing of the use of the technology, and the indications. Particular attention will be focused on the role of hemofiltration in an attempt to reduce the plasma levels of some of the mediators of the Systemic Inflammatory Response Syndrome (SIRS).
Collapse
|
11
|
Stephenson ER, Myers JL. Pediatric cardiopulmonary bypass. Ann Thorac Surg 2001; 72:2176-7. [PMID: 11789830 DOI: 10.1016/s0003-4975(01)02996-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- E R Stephenson
- Pediatric Cardiovascular Surgery, Penn State Children's Hospital, Penn State Hershey Medical Center, Hershey 17033, USA
| | | |
Collapse
|
12
|
Thompson LD, McElhinney DB, Findlay P, Miller-Hance W, Chen MJ, Minami M, Petrossian E, Parry AJ, Reddy VM, Hanley FL. A prospective randomized study comparing volume-standardized modified and conventional ultrafiltration in pediatric cardiac surgery. J Thorac Cardiovasc Surg 2001; 122:220-8. [PMID: 11479493 DOI: 10.1067/mtc.2001.114937] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Modified ultrafiltration has been touted as superior to conventional ultrafiltration for attenuating the consequences of hemodilution after cardiac surgery with cardiopulmonary bypass in children. We conducted a prospective randomized study to test the hypothesis that modified and conventional ultrafiltration have similar clinical effects when a standardized volume of fluid is removed. METHODS From October 1998 to September 1999, 110 children weighing 15 kg or less (median weight 6.1 kg, median age 6.3 months) undergoing surgery with cardiopulmonary bypass for functionally biventricular congenital heart disease were randomized to conventional (n = 67) or arteriovenous modified ultrafiltration (n = 43) for hemoconcentration. The volume of fluid removed with both methods was standardized as a percentage of effective fluid balance (the sum of prime volume and volume added during cardiopulmonary bypass minus urine output): in patients weighing less than 10 kg, 50% of effective fluid balance was removed, whereas 60% was removed in patients weighing 10 to 15 kg. Hematocrit, hemodynamics, ventricular function, transfusion of blood products, and postoperative resource use were compared between groups. RESULTS There were no significant differences between groups in age, weight, or duration of cardiopulmonary bypass. The total volume of fluid added in the prime and during bypass was greater in patients undergoing conventional ultrafiltration than in those receiving modified ultrafiltration (205 +/- 123 vs 162 +/- 74 mL/kg; P =.05), although the difference was due primarily to a greater indexed priming volume in patients having conventional ultrafiltration. There was no difference in the percentage of effective fluid balance that was removed in the 2 groups. Accordingly, the volume of ultrafiltrate was greater in patients receiving conventional than modified ultrafiltration (95 +/- 63 vs 68 +/- 28 mL/kg; P =.01). Preoperative and postoperative hematocrit levels were 35.6% +/- 6.6% and 36.3% +/- 5.6% in patients having conventional ultrafiltration and 34.4% +/- 6.7% and 38.7% +/- 7.5% in those having modified ultrafiltration. By repeated-measures analysis of variance, patients receiving modified and conventional ultrafiltration did not differ with respect to hematocrit value (P =.87), mean arterial pressure (P =.85), heart rate (P =.43), or left ventricular shortening fraction (P =.21) from baseline to the postbypass measurements. There were no differences between groups in duration of mechanical ventilation, stay in the intensive care unit, or hospitalization. CONCLUSIONS When a standardized volume of fluid is removed, hematocrit, hemodynamics, ventricular function, requirement for blood products, and postoperative resource use do not differ between pediatric patients receiving conventional and modified ultrafiltration for hemoconcentration after cardiac surgery.
Collapse
Affiliation(s)
- L D Thompson
- Division of Cardiothoracic Surgery, University of California, San Francisco 94143-0118, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Efficacy of haemofiltration during cardiopulmonary bypass in paediatric open heart surgery. Indian J Thorac Cardiovasc Surg 2001. [DOI: 10.1007/s12055-001-0010-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
14
|
Grünenfelder J, Zünd G, Schoeberlein A, Maly FE, Schurr U, Guntli S, Fischer K, Turina M. Modified ultrafiltration lowers adhesion molecule and cytokine levels after cardiopulmonary bypass without clinical relevance in adults. Eur J Cardiothorac Surg 2000; 17:77-83. [PMID: 10735416 DOI: 10.1016/s1010-7940(99)00355-3] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
OBJECTIVE Cardiac surgery with cardiopulmonary bypass (CPB) results in expression of cytokines and adhesion molecules (AM) with subsequent inflammatory response. The purpose of the study was to evaluate the clinical impact of modified ultrafiltration (MUF) and its efficacy in reducing cytokines and AM following coronary artery bypass grafting (CABG) in adults. METHODS A prospective randomized study of 97 patients undergoing elective CABG was designed. Fifty patients were operated on using normothermic and 47 patients using hypothermic CPB. The normothermic group was subdivided into a group with modified ultrafiltration (n = 30) and a group without MUF (n = 20). In the hypothermic group 30 patients received MUF compared to 17 patients serving as controls. MUF was instituted after CPB for 15 min through the arterial and venous bypass circuit lines. Cytokines (IL-6, IL-8, TNF-alpha, IL-2R) and adhesion molecules (sE-selectin, sICAM-1) were measured preoperatively, pre-MUF, in the ultrafiltrate, 24 h, 48 h and 6 days after surgery by chemiluminescent enzyme immunometric assay or enzyme-linked immunosorbent assay (ELISA). Clinical parameters were collected prospectively until discharge. RESULTS In all patients AM and cytokines were significantly elevated after normothermic and hypothemic CPB. AM and cytokines were significantly higher in hypothermia compared to normothermia. In hypothermic CPB sE-selectin was decreased after 24 h by 37% (P < 0.0063) and by 40% (P < 0.0027) after 48 h postoperatively. ICAM-1 was reduced by 43% (P < 0.0001) after 24 h and by 60% (P < 0.0001) after 6 days. Similar results were seen in cytokines with reduction up to 60% after 24 h. Changes after 48 h were noticeable but not significant. Reduction of AM and cytokines after normothermic CPB was minimal. Neither in normothermia, nor in hypothermia has sIL-2R been effectively removed from the circulation. There were no significant differences in the clinical variables between the patients with or without MUF. CONCLUSION AM and cytokines are significantly elevated after hypothermic CPB compared to normothermic CPB. MUF led to a significant reduction in cytokine and AM levels after hypothermic CPB, except for IL-2R. MUF showed minimal effect in normothermia. We conclude that MUF is an efficient way to remove cytokines and AM. However, we were unable to demonstrate any significant impact of MUF in outcome of adults after elective CABG.
Collapse
Affiliation(s)
- J Grünenfelder
- Clinic for Cardiovascular Surgery, University Hospital, Zürich, Switzerland
| | | | | | | | | | | | | | | |
Collapse
|