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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]
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Malaspinas I, Petak F, Chok L, Perrin A, Martin AL, Beghetti M, Habre W. Surgical Repair of Mitral Valve Disease in Children: Perioperative Changes in Respiratory Function. J Cardiothorac Vasc Anesth 2016; 30:1286-95. [PMID: 27495965 DOI: 10.1053/j.jvca.2016.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assess the profile of changes in airway and respiratory tissue mechanics within a follow-up study performed in children with mitral valve disease, before and after surgical valve repair. DESIGN Perioperative measurements in a prospective, consecutive cross-sectional study. SETTING University hospital, tertiary care teaching hospital PARTICIPANTS The study comprised 24 children with congenital or post-rheumatic mitral valve insufficiency. INTERVENTIONS Input impedance of the respiratory system during spontaneous breathing was measured before and 5 days and 3 weeks after mitral valve surgery. In addition, airway and respiratory tissue mechanics and pulmonary arterial pressure were assessed with the patient under general anesthesia preoperatively and immediately postoperatively. Respiratory tissue elastance and changes in airway measurements were estimated from forced oscillatory impedance data by fitting an appropriate model. MEASUREMENT AND MAIN RESULTS Relating airway and respiratory tissue mechanics to previously established reference values obtained in age-matched healthy control patients revealed abnormal respiratory function (135±6.2% and 148±13% in respiratory elastance and resistance, respectively; p<0.001). Improvement in the airway properties was observed immediately after surgery (-15.2±3.4%; p<0.005) and lasted for the study period (-19±4.1%; p<0.001). Respiratory tissue elastance, which correlated preoperatively to the diastolic pulmonary arterial pressure, decreased only 5 days postoperatively (-20.6±4.1%; p<0.005). However, there was no evidence of a clear, immediate effect of surgery on the tissue mechanical parameters measured intraoperatively despite a decrease in diastolic pulmonary pressure. CONCLUSIONS Mitral valve disease in children leads to abnormal airway and respiratory tissue mechanics. Even though surgical repair of mitral insufficiency alleviates abnormal airway function, residual lung tissue stiffening may persist even weeks after the surgery, contributing to a sustained impairment in lung function.
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Affiliation(s)
- Iliona Malaspinas
- Pediatric Anesthesia Unit, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland; †Unit for Anesthesiological Investigations, Department of Anesthesiology, Pharmacology and Intensive Care, University of Geneva, Geneva, Switzerland; ‡Pediatric Cardiology Unit, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Ferenc Petak
- §Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Lionel Chok
- Pediatric Anesthesia Unit, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Anne Perrin
- Pediatric Anesthesia Unit, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Anne-Laure Martin
- ‡Pediatric Cardiology Unit, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Maurice Beghetti
- ‡Pediatric Cardiology Unit, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Walid Habre
- Pediatric Anesthesia Unit, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland; †Unit for Anesthesiological Investigations, Department of Anesthesiology, Pharmacology and Intensive Care, University of Geneva, Geneva, Switzerland.
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Trachsel D, Svendsen J, Erb T, von Ungern-Sternberg B. Effects of anaesthesia on paediatric lung function. Br J Anaesth 2016; 117:151-63. [DOI: 10.1093/bja/aew173] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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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
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de Vries AJ, Gu YJ, van Oeveren W. Leucocyte filtration of residual heart-lung machine blood in children undergoing congenital heart surgery. Perfusion 2016; 19:345-9. [PMID: 15619967 DOI: 10.1191/0267659104pf765oa] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cardiopulmonary bypass (CPB) leads to a generalized inflammatory reaction, resulting in increased postoperative leucocyte counts and decreased pulmonary function. In adults, removal of leucocytes from the residual heart - lung machine blood after CPB improved postoperative oxygenation. In children, however, the clinical effects of leucocyte filtration of the residual heart - lung machine blood are unknown. Therefore, we measured postoperative leucocyte counts and arterial blood oxygenation in children undergoing congenital cardiac surgery in a randomized prospective study. Anaesthesia and CPB were standardized. After CPB, the residual heart-lung machine blood was collected as usual. In a group of 25 children, this blood was filtered with a leucocyte depletion filter before transfusion. A control group of 25 children received this blood unfiltered. We found that the postoperative leucocyte counts were significantly lower in the filter group than in the control group ( p=0.02, repeated measurements ANOVA). This difference reached a maximum on the second postoperative day (12.9×109/L filter versus 15.9×109/L control, p=0.02, Student’s t-test). Values for the arterial blood oxygenation on the first postoperative day were not different between the two groups (15.5±1 kPa filter versus 14.6±1.3 kPa control, p=0.57, Student’s t-test). We conclude that leucocyte filtration of the residual heart-lung machine blood reduced systemic leucocyte counts, but did not improve arterial blood oxygenation in children after congenital heart surgery.
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Affiliation(s)
- A J de Vries
- Department of Anaesthesiology, University Hospital Groningen, Groningen, The Netherlands. a.j.de.vries.@anest.azg.nl
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Chew MS, Brix-Christensen V, Ravn HB, Brandslund I, Ditlevsen E, Pedersen J, Hjortholm K, Hansen OK, Tønnesen E, Hjortdal VE. Effect of modified ultrafiltration on the inflammatory response in paediatric open-heart surgery: a prospective, randomized study. Perfusion 2016; 17:327-33. [PMID: 12243435 DOI: 10.1191/0267659102pf595oa] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Modified ultrafiltration (MUF) is often used in conjunction with paediatric cardiac surgery with cardiopulmonary bypass (CPB) and is thought to improve clinical outcome. It is unclear whether these improvements (if any) are due to the removal of inflammatory mediators. In this prospective study, 18 children aged 12-24 months undergoing uncomplicated cardiac surgery with methylprednisolone added in the pump prime were randomized to receive CPB with ( n= 10) and without ( n= 8) MUF. Cytokines (TNFα, IL-6, IL- 1β, IL-10, IL-1ra), complement split products (C3d, C4d) and coagulation system activation (F1+ 2, ATIII) were measured pre-, peri- and up to 48 h postoperatively. For clinical outcome, the alveolar-arterial oxygen (A-a) gradient, transfusion requirement, drain loss, mean blood pressure and requirement for inotropic support were registered up to 24 h postoperatively. Our results show an improvement in postoperative oxygenation as well as a tendency towards decreased drain loss and improved haemodynamics in the MUF group. There were no intergroup differences detectable for TNFα, IL-1β, IL-1ra, complement and coagulation markers. We conclude that MUF in itself does not significantly influence TNFα, IL-1β, IL-1ra and the complement and coagulation profiles in children undergoing cardiac surgerywith CPB. Despite this, there was some evidence for improved clinical outcome. Our results do not support that MUF improves postoperative organ function by modulation of the measured markers of inflammation.
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Affiliation(s)
- Michelle S Chew
- Department of Anaesthesia and Intensive Care, Institute of Experimental Clinical Research, Aarhus University Hospital, Denmark.
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Agha H, El Heinady F, El Falaky M, Sobih A. Pulmonary functions before and after pediatric cardiac surgery. Pediatr Cardiol 2014; 35:542-9. [PMID: 24169858 DOI: 10.1007/s00246-013-0821-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 10/03/2013] [Indexed: 11/29/2022]
Abstract
This study aimed to assess pulmonary functions before and after cardiac surgery in infants with congenital heart diseases and pulmonary overflow and to clarify which echocardiographic parameter correlates best with lung mechanics. Between 2008 and 2009, 30 infants with left-to-right shunt congenital acyanotic heart diseases who had indications for reparative surgery of these lesions were assessed by echocardiography and infant pulmonary function tests before the operation and 6 months afterward. Tests using baby body plethysmography were performed to assess the following infant pulmonary functions: tidal volume, respiratory rate, respiratory system compliance (C(rs)) and respiratory system resistance, functional residual capacity (FRC), and airway resistance. The mean age of the patients was 10.47 ± 3.38 months, and their mean weight was 6.81 ± 1.67 kg. Ventricular septal defect and combined lesions were the predominant cardiac diseases (26.7%). Comparison of the infant pulmonary function tests showed a highly significant improvement in all the parameters between the preoperative and 6-month postoperative visits (p < 0.0001). Systolic pulmonary artery pressure had a statistically significant negative correlation with C(rs) (r = -0.493, p = 0.006) and a positive correlation with FRC (r = 0.450, p = 0.013). The findings showed that C(rs) had a statistically significant negative correlation with the pulmonary artery size (r = -0.398, p = 0.029) and the left atrium size (r = -0.395, p = 0.031), whereas the pulmonary artery size had a statistically positive correlation with effective resistance (r = 0.416, p = 0.022) and specific effective resistance (r = 0.604, p = 0.0001). Surgical correction of left-to-right shunt congenital heart diseases had a positive impact on lung compliance, airway resistance, and FRC. Noninvasive echocardiographic parameters assessing pulmonary vascular engorgement and pulmonary artery pressure were closely related to these infant pulmonary function test indexes.
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Affiliation(s)
- Hala Agha
- Pediatric Cardiology Unit, Pediatric Department, Children Hospital, Cairo University, El Kasr El Aini St., Garden City, Cairo, Egypt,
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Abramo A, Di Salvo C, Baldi G, Marini E, Anselmino M, Salvetti G, Giunta F, Forfori F. Xenon anesthesia reduces TNFα and IL10 in bariatric patients. Obes Surg 2012; 22:208-12. [PMID: 21559793 DOI: 10.1007/s11695-011-0433-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Anesthesia is able to modulate the balance between proinflammatory and anti-inflammatory cytokine production during surgery. The aim of this study is to assess the effect of three anesthesia approaches, total intravenous anesthesia (TIVA), inhalation anesthesia, and xenon anesthesia, on sieric levels of nitric oxide (NO), IL6, IL10, and TNFα in obese patients undergoing Roux-en-Y laparoscopic gastric bypass. METHODS Thirty adult morbidly obese patients (BMI > 35) scheduled for Roux-en-Y laparoscopic gastric bypass were randomly recruited and allocated to TIVA (N = 10), inhalation anesthesia (SEV, N = 10), and xenon anesthesia (XE, N = 10). Exclusion criteria were ASA IV, age <18 or >60 years, and Mallampati IV. Opioid dosage and ventilation parameters were standardized. Sieric levels of NO, IL6, IL10, and TNFα were assessed at T0 (before induction of anesthesia), T1 (end of surgery), and T2 (12 h after the end of surgery). We compared the relative cytokine level variations (delta) at T1 and T2 and the cytokine exposure levels calculated as the area under the curve (AUC) between T0 and T2 in the XE and non-XE (SEV + TIVA) groups. RESULTS At T1, we found a significant ΔIL10 (reduction) and ΔTNFα (reduction) between XE and SEV (p < 0.05) and XE and TIVA (p < 0.05) groups. At T2, ΔIL10 was still significant. Furthermore, we found a reduced AUC value for TNFα in the XE group. CONCLUSIONS Xenon anesthesia seems able to inhibit postoperative proinflammatory cytokine imbalance in morbidly obese patients undergoing Roux-en-Y laparoscopic gastric bypass; the reduced ΔTNFα at T1 and the reduced global exposition to TNFα in the XE group may explain the reduced ΔIL10 at T1 and T2.
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Affiliation(s)
- Antonio Abramo
- Anestesia e Rianimazione Universitaria IV, Azienda Ospedaliera Universitaria Pisana, Cisanello, Via Paradisa 2, Pisa 56100, Italy.
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Bikker IG, Scohy TV, Ad J J C Bogers, Bakker J, Gommers D. Measurement of end-expiratory lung volume in intubated children without interruption of mechanical ventilation. Intensive Care Med 2009; 35:1749-53. [PMID: 19626312 PMCID: PMC2749178 DOI: 10.1007/s00134-009-1579-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Accepted: 06/20/2009] [Indexed: 11/22/2022]
Abstract
Purpose Monitoring end-expiratory lung volume (EELV) is a valuable tool to optimize respiratory settings that could be of particular importance in mechanically ventilated pediatric patients. We evaluated the feasibility and precision of an intensive care unit (ICU) ventilator with an in-built nitrogen washout/washin technique in mechanically ventilated pediatric patients. Methods Duplicate EELV measurements were performed in 30 patients between 5 kg and 43 kg after cardiac surgery (age, median + range: 26, 3–141 months). All measurements were taken during pressure-controlled ventilation at 0 cm H2O of positive end-expiratory pressure (PEEP). Results Linear regression between duplicate measurements was excellent (R2 = 0.99). Also, there was good agreement between duplicate measurements, bias ± SD: −0.3% (−1.5 mL) ± 5.9% (19.2 mL). Mean EELV ± SD was 19.6 ± 5.1 mL/kg at 0 cm H2O PEEP. EELV correlated with age (p < 0.001, r = 0.92, R2 = 0.78), body weight (p < 0.001, r = 0.91, R2 = 0.82) and height (p < 0.001, r = 0.94, R2 = 0.75). Conclusion This ICU ventilator with an in-built nitrogen washout/washin EELV technique can measure EELV with precision, and can easily be used for mechanically ventilated pediatric patients.
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Affiliation(s)
- Ido G Bikker
- Department of Intensive Care Medicine, Erasmus MC, Room H602, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
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Ando M, Murai T, Takahashi Y. The effect of sivelestat sodium on post-cardiopulmonary bypass acute lung injury in a neonatal piglet model. Interact Cardiovasc Thorac Surg 2008; 7:785-8. [DOI: 10.1510/icvts.2008.177576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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von Ungern-Sternberg BS, Petak F, Saudan S, Pellegrini M, Erb TO, Habre W. Effect of cardiopulmonary bypass and aortic clamping on functional residual capacity and ventilation distribution in children. J Thorac Cardiovasc Surg 2007; 134:1193-8. [DOI: 10.1016/j.jtcvs.2007.03.061] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2006] [Revised: 03/28/2007] [Accepted: 03/29/2007] [Indexed: 11/29/2022]
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Zeyneloglu P, Donmez A, Bilezikci B, Mercan S. Effects of Ketamine on Serum and Tracheobronchial Aspirate Interleukin-6 Levels in Infants Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth 2005; 19:329-33. [PMID: 16130059 DOI: 10.1053/j.jvca.2005.03.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Corrective surgery for congenital heart defects in children frequently requires cardiopulmonary bypass (CPB). Serum and bronchoalveolar levels of interleukin-6 (IL-6) may be useful in assessing the severity of the systemic inflammatory response after CPB. In the present study, the authors aimed to compare the effects of ketamine anesthesia and isoflurane anesthesia with respect to serum and tracheobronchial aspirate (TBA) IL-6 levels in infants undergoing CPB for cardiac surgery. DESIGN Prospective and randomized controlled study. SETTING University-based teaching hospital. PARTICIPANTS Thirty-four infants aged 2 to 24 months were randomized into 2 groups. INTERVENTIONS In group K (n = 17), anesthesia was induced with intravenous (IV) ketamine, 1 to 2 mg/kg, and fentanyl, 1 to 2 microg/kg, and was maintained with infusions of ketamine, 25 to 75 microg/kg/min, and fentanyl, 10 microg/kg/h. In group I (n = 17), induction was achieved with IV thiopental sodium, 3 to 5 mg/kg, and fentanyl, 1 to 2 microg/kg, and was maintained with 1% isoflurane and fentanyl, 10 mug/kg/h. Blood and TBA samples were obtained at 6 and 4 stages, respectively. MEASUREMENTS AND MAIN RESULTS Serum IL-6 and TBA IL-6 levels were similar in the 2 groups at all stages (p > 0.05). CONCLUSION The present results show that ketamine anesthesia does not provide superiority over isoflurane anesthesia with respect to serum and TBA IL-6 levels.
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Affiliation(s)
- Pinar Zeyneloglu
- Department of Anesthesiology, Baskent University Faculty of Medicine, Ankara, Turkry.
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Stayer SA, Diaz LK, East DL, Gouvion JN, Vencill TL, McKenzie ED, Fraser CD, Andropoulos DB. Changes in respiratory mechanics among infants undergoing heart surgery. Anesth Analg 2004; 98:49-55. [PMID: 14693582 DOI: 10.1213/01.ane.0000096005.25218.74] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED Children with excessive pulmonary blood flow (PBF) from congenital heart disease have abnormal respiratory mechanics. Exposure to hypothermic cardiopulmonary bypass (CPB) adversely affects lung function. We designed this study of 106 patients to determine the changes in respiratory mechanics in infants younger than 1 yr undergoing heart surgery. Dynamic respiratory compliance (Cdyn) and total respiratory resistance (Rrs) were measured before surgical incision, after sternal closure in the operating room, and after arrival in the intensive care unit. The following data were recorded: age, weight, preoperative pulmonary infiltrates, preoperative mechanical ventilation, evidence of increased PBF before surgery, duration of CPB, duration of aortic cross-clamp, duration of deep hypothermic circulatory arrest, use of steroids, and volume of ultrafiltrate removed. Repeated-measures analysis of variance with covariate analysis was used to determine the effect of each covariate on Cdyn and Rrs at the three time periods. Rrs improved after cardiac surgery correcting increases in PBF, and this was most pronounced in neonates. Among infants with normal or reduced PBF, cardiac surgery with CPB led to a reduction in Cdyn. We consider that the benefits of surgical correction of pulmonary overcirculation outweigh the negative effects of CPB on respiratory mechanics. IMPLICATIONS The benefits of surgical correction of pulmonary overcirculation outweigh the negative effects of cardiopulmonary bypass on respiratory mechanics in infants.
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Affiliation(s)
- Stephen A Stayer
- Departments of *Anesthesiology, †Pediatrics, and ¶Surgery, Divisions of ‡Pediatric Cardiovascular Anesthesiology and §Congenital Heart Surgery, Baylor College of Medicine, ∥Texas Children's Hospital, Houston, Texas
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Brix-Christensen V, Tønnesen E, Hjortdal VE, Chew M, Flø C, Marqversen J, Hansen JF, Andersen NT, Ravn HB. Neutrophils and platelets accumulate in the heart, lungs, and kidneys after cardiopulmonary bypass in neonatal pigs. Crit Care Med 2002; 30:670-6. [PMID: 11990932 DOI: 10.1097/00003246-200203000-00029] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Cardiac surgery with cardiopulmonary bypass elicits a systemic inflammatory response. An exaggerated response is associated with organ dysfunction and increased morbidity and mortality. DESIGN The aim of the present study was to investigate whether the cardiopulmonary bypass procedure in itself results in accumulation of isotope-labeled platelets, polymorphonuclear neutrophils, and fibrinogen at organ levels in neonatal pigs and to monitor changes in organ function. SETTING Pediatric cardiopulmonary bypass setup with 60 mins of aortic cross-clamp time and 120 mins of hypothermic cardiopulmonary bypass time. SUBJECTS Thirty piglets were allocated to sternotomy alone (sham group, n = 15) or to sternotomy and cardiopulmonary bypass (n = 15). MEASUREMENTS AND MAIN RESULTS Isotope-labeled autologous polymorphonuclear neutrophils, platelets, and commercially available fibrinogen were infused, and the specific accumulation at organ level was measured in a gamma counter 4 hrs after termination of cardiopulmonary bypass. Concomitant changes in oxygenation index and cardiac output were registered. Animals exposed to cardiopulmonary bypass showed a significantly higher technetium-99m-polymorphonuclear neutrophil accumulation in the lungs and kidneys, whereas indium-111-platelets accumulated in the heart and kidneys compared with the sham group. There was a significantly larger increase in oxygenation index and significantly larger decrease in cardiac output between the pre- and postcardiopulmonary bypass period in the cardiopulmonary bypass group compared with the sham group. CONCLUSIONS The cardiopulmonary bypass procedure without cardiac surgery elicits organ dysfunction in terms of impaired respiratory and hemodynamic function. Platelets and polymorphonuclear neutrophils were entrapped in the heart, lungs, and kidneys of cardiopulmonary bypass animals, indicating that cell accumulation may contribute to the developing organ dysfunction.
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Brix-Christensen V. The systemic inflammatory response after cardiac surgery with cardiopulmonary bypass in children. Acta Anaesthesiol Scand 2001; 45:671-9. [PMID: 11421823 DOI: 10.1034/j.1399-6576.2001.045006671.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Paediatric cardiac surgery often requires cardiopulmonary bypass (CPB) during the surgical intervention. CPB is known to elicit a systemic inflammatory response with activation of the complement and coagulation systems, stimulation of cytokine production, cellular entrapment in organs, neutrophil activation with degranulation, platelet activation, and endothelial dysfunction. These changes are associated with a risk of postoperative organ dysfunction and increased morbidity and mortality in the postoperative period. Clinical studies have concentrated on measurement of inflammatory markers and mediators in peripheral blood, where the systemic inflammatory response in the paediatric cardiac patient seems to be different from the adult case. Looking at the organ level, experimental studies have the advantage of providing information contributing to a better understanding of the pathological events that may lead to the deteriorated organ function. This review focuses on the systemic inflammatory response after cardiac surgery with CPB in children and experimental CPB models.
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Affiliation(s)
- V Brix-Christensen
- Department of Anaesthesiology and Institute of Experimental Clinical Research, Aarhus University Hospital, Denmark.
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