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Abbasciano RG, Tomassini S, Roman MA, Rizzello A, Pathak S, Ramzi J, Lucarelli C, Layton G, Butt A, Lai F, Kumar T, Wozniak MJ, Murphy GJ. Effects of interventions targeting the systemic inflammatory response to cardiac surgery on clinical outcomes in adults. Cochrane Database Syst Rev 2023; 10:CD013584. [PMID: 37873947 PMCID: PMC10594589 DOI: 10.1002/14651858.cd013584.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
BACKGROUND Organ injury is a common and severe complication of cardiac surgery that contributes to the majority of deaths. There are no effective treatment or prevention strategies. It has been suggested that innate immune system activation may have a causal role in organ injury. A wide range of organ protection interventions targeting the innate immune response have been evaluated in randomised controlled trials (RCTs) in adult cardiac surgery patients, with inconsistent results in terms of effectiveness. OBJECTIVES The aim of the review was to summarise the results of RCTs of organ protection interventions targeting the innate immune response in adult cardiac surgery. The review considered whether the interventions had a treatment effect on inflammation, important clinical outcomes, or both. SEARCH METHODS CENTRAL, MEDLINE, Embase, conference proceedings and two trial registers were searched on October 2022 together with reference checking to identify additional studies. SELECTION CRITERIA RCTs comparing organ protection interventions targeting the innate immune response versus placebo or no treatment in adult patients undergoing cardiac surgery where the treatment effect on innate immune activation and on clinical outcomes of interest were reported. DATA COLLECTION AND ANALYSIS Searches, study selection, quality assessment, and data extractions were performed independently by pairs of authors. The primary inflammation outcomes were peak IL-6 and IL-8 concentrations in blood post-surgery. The primary clinical outcome was in-hospital or 30-day mortality. Treatment effects were expressed as risk ratios (RR) and standardised mean difference (SMD) with 95% confidence intervals (CI). Meta-analyses were performed using random effects models, and heterogeneity was assessed using I2. MAIN RESULTS A total of 40,255 participants from 328 RCTs were included in the synthesis. The effects of treatments on IL-6 (SMD -0.77, 95% CI -0.97 to -0.58, I2 = 92%) and IL-8 (SMD -0.92, 95% CI -1.20 to -0.65, I2 = 91%) were unclear due to heterogeneity. Heterogeneity for inflammation outcomes persisted across multiple sensitivity and moderator analyses. The pooled treatment effect for in-hospital or 30-day mortality was RR 0.78, 95% CI 0.68 to 0.91, I2 = 0%, suggesting a significant clinical benefit. There was little or no treatment effect on mortality when analyses were restricted to studies at low risk of bias. Post hoc analyses failed to demonstrate consistent treatment effects on inflammation and clinical outcomes. Levels of certainty for pooled treatment effects on the primary outcomes were very low. AUTHORS' CONCLUSIONS A systematic review of RCTs of organ protection interventions targeting innate immune system activation did not resolve uncertainty as to the effectiveness of these treatments, or the role of innate immunity in organ injury following cardiac surgery.
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Affiliation(s)
| | | | - Marius A Roman
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Angelica Rizzello
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Suraj Pathak
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Joussi Ramzi
- Leicester Medical School, University of Leicester, Leicester, UK
| | - Carla Lucarelli
- Department of Cardiac Surgery, University of Verona, Verona, Italy
| | - Georgia Layton
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Ayesha Butt
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Florence Lai
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Tracy Kumar
- Leicester Clinical Trials Unit, University of Leicester, Leicester, UK
| | - Marcin J Wozniak
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Gavin J Murphy
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
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The impact of oxygen supply and erythrocytes during normothermic kidney perfusion. Sci Rep 2023; 13:2021. [PMID: 36737505 PMCID: PMC9898236 DOI: 10.1038/s41598-023-29031-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
The influence of erythrocytes and oxygen concentration on kidneys during long-term normothermic kidney perfusion is under debate. This study compares acellular and erythrocyte-based NMP with focus on oxygen delivery to the tissue as well as the effects of high oxygenation on tissue integrity. Pig kidneys were connected to NMP for six hours. The first group (n = 6; AC500) was perfused without addition of oxygen carriers, arterial perfusate pO2 was maintained at 500 mmHg. In the second group (n = 6; RBC500) washed erythrocytes were added to the perfusate at pO2 of 500 mmHg. Third group (n = 6; RBC200) was perfused with erythrocyte containing perfusate at more physiological pO2 of 200 mmHg. Addition of RBC did not relevantly increase oxygen consumption of the kidneys during perfusion. Likewise, there were no differences in kidney functional and injury parameters between AC500 and RBC500 group. Expression of erythropoietin as indicator of tissue hypoxia was comparable in all three groups. Cell free NMP at supraphysiological oxygen partial pressure seems to be a safe alternative to erythrocyte based perfusion without adverse effect on kidney integrity and provides a less cumbersome application of NMP in clinical practice.
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Moein M, Ahmed M, Arafa F, Saidi RF. Hemoglobin-based oxygen carriers: Clinical application of HBOC-201 as an alternative to red blood cells for machine perfusion in liver transplantation. SURGERY IN PRACTICE AND SCIENCE 2022. [DOI: 10.1016/j.sipas.2022.100120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Renal Protection Against Ischemia Reperfusion Injury: Hemoglobin-based Oxygen Carrier-201 Versus Blood as an Oxygen Carrier in Ex Vivo Subnormothermic Machine Perfusion. Transplantation 2020; 104:482-489. [PMID: 31568396 DOI: 10.1097/tp.0000000000002967] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND The optimal method of oxygen delivery to donor kidneys during ex vivo machine perfusion has not been established. We have recently reported the beneficial effects of subnormothermic (22°C) blood perfusion in the preservation of porcine donation after circulatory death kidneys. Since using blood as a clinical perfusate has limitations, including matching availability and potential presence of pathogen, we sought to assess hemoglobin-based oxygen carrier (HBOC-201) in oxygen delivery to the kidney for renal protection. METHODS Pig kidneys (n = 5) were procured after 30 minutes of warm in situ ischemia by cross-clamping the renal arteries. Organs were flushed with histidine tryptophan ketoglutarate solution and subjected to static cold storage or pulsatile perfusion with an RM3 pump at 22°C for 4 hours with HBOC-201 and blood. Thereafter, kidneys were reperfused with normothermic (37°C) oxygenated blood for 4 hours. Blood and urine were subjected to biochemical analysis. Total urine output, urinary protein, albumin/creatinine ratio, flow rate, resistance were measured. Acute tubular necrosis, apoptosis, urinary kidney damage markers, neutrophil gelatinase-associated lipocalin 1, and interleukin 6 were also assessed. RESULTS HBOC-201 achieved tissues oxygen saturation equivalent to blood. Furthermore, upon reperfusion, HBOC-201 treated kidneys had similar renal blood flow and function compared with blood-treated kidneys. Histologically, HBOC-201 and blood-perfused kidneys had vastly reduced acute tubular necrosis scores and degrees of terminal deoxynucleotidyl transferase 2'-deoxyuridine, 5'-triphosphate nick end labeling staining versus kidneys treated with cold storage. Urinary damage markers and IL6 levels were similarly reduced by both blood and HBOC-201. CONCLUSIONS HBOC-201 is an excellent alternative to blood as an oxygen-carrying molecule in an ex vivo subnormothermic machine perfusion platform in kidneys.
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Liu A, Sun Z, Liu Q, Zhu N, Wang S. Pumping O2 with no N2: An Overview of Hollow Fiber Membrane Oxygenators with Integrated Arterial Filters. Curr Top Med Chem 2019; 20:78-85. [PMID: 31820691 DOI: 10.2174/1568026619666191210161013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/01/2019] [Accepted: 10/20/2019] [Indexed: 11/22/2022]
Abstract
The advancement of cardiac surgery benefits from the continual technological progress of cardiopulmonary bypass (CPB). Every improvement in the CPB technology requires further clinical and laboratory tests to prove its safety and effectiveness before it can be widely used in clinical practice. In order to reduce the priming volume and eliminate a separate arterial filter in the CPB circuit, several manufacturers developed novel hollow-fiber membrane oxygenators with integrated arterial filters (IAF). Clinical and experimental studies demonstrated that an oxygenator with IAF could reduce total priming volume, blood donor exposure and gaseous microemboli delivery to the patient. It can be easily set up and managed, simplifying the CPB circuit without sacrificing safety. An oxygenator with IAF is expected to be more beneficial to the patients with low body weight and when using a minimized extracorporeal circulation system. The aim of this review manuscript was to discuss briefly the concept of integration, the current oxygenators with IAF, and the in-vitro / in-vivo performance of the oxygenators with IAF.
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Affiliation(s)
- Anxin Liu
- Center for Cardiac Intensive Care, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhiquan Sun
- Center for Cardiac Intensive Care, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Qier Liu
- Biologic Sciences, College of Liberal Arts and Sciences, University of Connecticut, Storrs, CT, United States
| | - Ning Zhu
- Hunan University of Medicine, Huaihua, Hunan, China
| | - Shigang Wang
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, United States
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Aburawi MM, Fontan FM, Karimian N, Eymard C, Cronin S, Pendexter C, Nagpal S, Banik P, Ozer S, Mahboub P, Delmonico FL, Yeh H, Uygun K, Markmann JF. Synthetic hemoglobin-based oxygen carriers are an acceptable alternative for packed red blood cells in normothermic kidney perfusion. Am J Transplant 2019; 19:2814-2824. [PMID: 30938927 PMCID: PMC6763345 DOI: 10.1111/ajt.15375] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/26/2019] [Accepted: 03/20/2019] [Indexed: 01/25/2023]
Abstract
Normothermic machine perfusion presents a novel platform for pretransplant assessment and reconditioning of kidney grafts. Maintaining the metabolic activity of a preserved graft at physiologic levels requires an adequate oxygen supply, typically delivered by crystalloid solutions supplemented with red blood cells. In this study, we explored the feasibility of using a synthetic hemoglobin-based oxygen carrier (HBOC) in human kidney normothermic perfusion. Fourteen discarded human kidneys were perfused for 6 hours at a mean temperature of 37°C using a pressure-controlled system. Kidneys were perfused with a perfusion solution supplemented with either HBOC (n = 7) or packed red blood cells (PRBC) (n = 7) to increase oxygen-carrying capacity. Renal artery resistance, oxygen extraction, metabolic activity, energy stores, and histological features were evaluated. Throughout perfusion, kidneys from both groups exhibited comparable behavior regarding vascular flow (P = .66), oxygen consumption (P = .88), and reconstitution of tissue adenosine triphosphate (P = .057). Lactic acid levels were significantly higher in kidneys perfused with PRBC (P = .007). Histological findings were comparable between groups, and there was no evidence of histological damage caused by the HBOC. This feasibility experiment demonstrates that a HBOC solution can offer a logistically more convenient off-the-shelf alternative to PRBC in normothermic machine perfusion of human kidneys.
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Affiliation(s)
- Mohamed M Aburawi
- Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Fermin M Fontan
- Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Negin Karimian
- Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts,Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Corey Eymard
- Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stephanie Cronin
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Casie Pendexter
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sonal Nagpal
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Peony Banik
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sinan Ozer
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Paria Mahboub
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Francis L Delmonico
- Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts,New England Donor Services, Waltham, Massachusetts
| | - Heidi Yeh
- Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Korkut Uygun
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - James F Markmann
- Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Busch C, Pfitzer C, Raschzok S, Miera O, Berger F, Schmitt KR. Clinical outcome and inflammatory response after transfusion of washed and unwashed red blood cells in children following cardiovascular surgery. PROGRESS IN PEDIATRIC CARDIOLOGY 2017. [DOI: 10.1016/j.ppedcard.2017.06.004] [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: 11/26/2022]
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The Use of an Acellular Oxygen Carrier in a Human Liver Model of Normothermic Machine Perfusion. Transplantation 2017; 101:2746-2756. [PMID: 28520579 DOI: 10.1097/tp.0000000000001821] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Normothermic machine perfusion of the liver (NMP-L) is a novel technique that preserves liver grafts under near-physiological conditions while maintaining their normal metabolic activity. This process requires an adequate oxygen supply, typically delivered by packed red blood cells (RBC). We present the first experience using an acellular hemoglobin-based oxygen carrier (HBOC) Hemopure in a human model of NMP-L. METHODS Five discarded high-risk human livers were perfused with HBOC-based perfusion fluid and matched to 5 RBC-perfused livers. Perfusion parameters, oxygen extraction, metabolic activity, and histological features were compared during 6 hours of NMP-L. The cytotoxicity of Hemopure was also tested on human hepatic primary cell line cultures using an in vitro model of ischemia reperfusion injury. RESULTS The vascular flow parameters and the perfusate lactate clearance were similar in both groups. The HBOC-perfused livers extracted more oxygen than those perfused with RBCs (O2 extraction ratio 13.75 vs 9.43 % ×10 per gram of tissue, P = 0.001). In vitro exposure to Hemopure did not alter intracellular levels of reactive oxygen species, and there was no increase in apoptosis or necrosis observed in any of the tested cell lines. Histological findings were comparable between groups. There was no evidence of histological damage caused by Hemopure. CONCLUSIONS Hemopure can be used as an alternative oxygen carrier to packed red cells in NMP-L perfusion fluid.
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Shi H, Lu R, Wang S, Chen H, Wang F, Liu K. Effects of SDF-1/CXCR4 on Acute Lung Injury Induced by Cardiopulmonary Bypass. Inflammation 2017; 40:937-945. [DOI: 10.1007/s10753-017-0538-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Brocca A, Virzì GM, de Cal M, Giavarina D, Carta M, Ronco C. Elevated Levels of Procalcitonin and Interleukin-6 are Linked with Postoperative Complications in Cardiac Surgery. Scand J Surg 2017; 106:318-324. [PMID: 28737097 DOI: 10.1177/1457496916683096] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Cardiac surgery-associated acute kidney injury is a frequent and serious postoperative complication of cardiac surgery and is associated with an increased risk of morbidity, mortality, and length stay. In this study, we hypothesized that persistent elevation in inflammation in the first 48 h might be a powerful predictor of clinical outcome. Our aim was to elucidate the usefulness of interleukin-6 and procalcitonin postoperative levels in predicting mortality and renal complications in cardiac surgery patients. METHODS A total of 122 cardiac surgery patients were enrolled. Procalcitonin and interleukin-6 concentrations were measured on the second postoperative day, and their levels were evaluated versus a number of conditions and endpoints. RESULTS Procalcitonin has a good predictive value for adverse renal outcome (p < 0.05). Interleukin-6 has a good predictive value for 30 days and overall mortality in cardiac surgery population (p < 0.05). We did not observe a significant difference in procalcitonin and interleukin-6 levels among patients with different types of surgery and different extracorporeal circulation time, but the levels of both the molecules increase significantly depending on number of transfusions received by patients (p < 0.01). CONCLUSION We speculated that procalcitonin and interleukin-6 could be two effective biomarkers. There is a possibility of having a combined inflammatory multi-biomarker panel, with procalcitonin for predicting renal outcome and interleukin-6 for predicting mortality.
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Affiliation(s)
- A Brocca
- 1 IRRIV-International Renal Research Institute of Vicenza, Vicenza, Italy.,2 Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.,3 Department of Medicine-DIMED, Medical School, University of Padova, Padova, Italy
| | - G M Virzì
- 1 IRRIV-International Renal Research Institute of Vicenza, Vicenza, Italy.,2 Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - M de Cal
- 1 IRRIV-International Renal Research Institute of Vicenza, Vicenza, Italy.,2 Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - D Giavarina
- 4 Clinical Chemistry and Haematology Laboratory, San Bortolo Hospital, Vicenza, Italy
| | - M Carta
- 4 Clinical Chemistry and Haematology Laboratory, San Bortolo Hospital, Vicenza, Italy
| | - C Ronco
- 1 IRRIV-International Renal Research Institute of Vicenza, Vicenza, Italy.,2 Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
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Mizuno T, Kamiyama H, Mizuno M, Mizukoshi T, Shinoda A, Harada K, Uchida S, Lee JS, Kasuya A, Sawada T, Uechi M. Plasma cytokine levels in dogs undergoing cardiopulmonary bypass. Res Vet Sci 2015; 101:99-105. [PMID: 26267098 DOI: 10.1016/j.rvsc.2015.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 02/25/2015] [Accepted: 03/01/2015] [Indexed: 11/17/2022]
Abstract
UNLABELLED Currently, there are no reports of inflammatory responses to CPB in dogs. We investigated the time course of pro- and anti-inflammatory cytokine levels during and after CPB. ANIMALS The study group included 11 dogs that underwent mitral valve repair with CPB, and the control group included 7 healthy dogs that underwent ovariohysterectomy. METHODS Blood samples from the study group dogs were collected before, during and after surgery and analyzed for plasma levels of interleukin-6 (IL-6), tissue necrosis factor-α (TNF-α), interleukin-10 (IL-10), white blood cells (WBC), and C-reactive protein (CRP). Each inflammatory parameter was also compared with that of the control group dogs. RESULTS After CPB, plasma levels of IL-6, WBC counts, and CRP levels were significantly higher than preoperative levels, and IL-6 levels in the study group were significantly higher than those in the control group. CONCLUSIONS CPB induces a systemic inflammatory response in dogs.
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Affiliation(s)
- Takeshi Mizuno
- JASMINE Veterinary Cardiovascular Medical Center, Japan Animal Specialty Medical Institute Inc., 2-7-3 Nakagawa, Tsuzuki, Yokohama, Kanagawa 224-0001, Japan
| | - Hiroshi Kamiyama
- Veterinary Cardiovascular Medicine and Surgery Unit, Veterinary Internal Medicine, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, 1866 Kameino, Fujisawa, Kanagawa 252-8510, Japan
| | - Masashi Mizuno
- JASMINE Veterinary Cardiovascular Medical Center, Japan Animal Specialty Medical Institute Inc., 2-7-3 Nakagawa, Tsuzuki, Yokohama, Kanagawa 224-0001, Japan
| | - Takahiro Mizukoshi
- JASMINE Veterinary Cardiovascular Medical Center, Japan Animal Specialty Medical Institute Inc., 2-7-3 Nakagawa, Tsuzuki, Yokohama, Kanagawa 224-0001, Japan
| | - Asako Shinoda
- JASMINE Veterinary Cardiovascular Medical Center, Japan Animal Specialty Medical Institute Inc., 2-7-3 Nakagawa, Tsuzuki, Yokohama, Kanagawa 224-0001, Japan
| | - Kayoko Harada
- JASMINE Veterinary Cardiovascular Medical Center, Japan Animal Specialty Medical Institute Inc., 2-7-3 Nakagawa, Tsuzuki, Yokohama, Kanagawa 224-0001, Japan
| | - Shuhei Uchida
- JASMINE Veterinary Cardiovascular Medical Center, Japan Animal Specialty Medical Institute Inc., 2-7-3 Nakagawa, Tsuzuki, Yokohama, Kanagawa 224-0001, Japan
| | - Joon-seok Lee
- JASMINE Veterinary Cardiovascular Medical Center, Japan Animal Specialty Medical Institute Inc., 2-7-3 Nakagawa, Tsuzuki, Yokohama, Kanagawa 224-0001, Japan
| | - Arane Kasuya
- JASMINE Veterinary Cardiovascular Medical Center, Japan Animal Specialty Medical Institute Inc., 2-7-3 Nakagawa, Tsuzuki, Yokohama, Kanagawa 224-0001, Japan
| | - Tamotsu Sawada
- JASMINE Veterinary Cardiovascular Medical Center, Japan Animal Specialty Medical Institute Inc., 2-7-3 Nakagawa, Tsuzuki, Yokohama, Kanagawa 224-0001, Japan
| | - Masami Uechi
- JASMINE Veterinary Cardiovascular Medical Center, Japan Animal Specialty Medical Institute Inc., 2-7-3 Nakagawa, Tsuzuki, Yokohama, Kanagawa 224-0001, Japan.
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Durandy Y. Minimizing Systemic Inflammation During Cardiopulmonary Bypass in the Pediatric Population. Artif Organs 2013; 38:11-8. [DOI: 10.1111/aor.12195] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Yves Durandy
- Department of Perfusion and Intensive Care; CCML; Le Plessis-Robinson France
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Hall R. Identification of Inflammatory Mediators and Their Modulation by Strategies for the Management of the Systemic Inflammatory Response During Cardiac Surgery. J Cardiothorac Vasc Anesth 2013; 27:983-1033. [DOI: 10.1053/j.jvca.2012.09.013] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Indexed: 12/21/2022]
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Sitniakowsky LS, Later AFL, van de Watering LMG, Bogaerts M, Brand A, Klautz RJM, Smit NPM, van Hilten JA. The effect of RBC transfusions on cytokine gene expression after cardiac surgery in patients developing post-operative multiple organ failure. Transfus Med 2011; 21:236-46. [PMID: 21518046 DOI: 10.1111/j.1365-3148.2011.01075.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
AIM To determine the effect of red blood cell (RBC) transfusions during cardiac surgery on cytokine gene expression (GE) in relation to multiple organ failure (MOF) development after systemic inflammatory response syndrome (SIRS). BACKGROUND RBC transfusion in cardiac surgery patients is dose-dependently associated with post-operative MOF, possibly acting as a second hit after cardiopulmonary bypass. METHODS For this observational study, 29 patients divided into four groups of cardiac surgery patients were selected from a randomised controlled trial (RCT). Group 1: no-RBC, no-MOF (N = 8); group 2: MOF, no-RBC (N = 7); group 3: RBC, no-MOF (N = 6); group 4: RBC and MOF (N = 8). Selection was based on age, gender, number of (leukocyte-depleted) RBC transfusions, type and duration of surgery. A 114 cytokine GE array was applied to blood samples withdrawn before and 24 h after surgery. Expression of selected genes was confirmed with reverse transcriptase real time-polymerase chain reaction (RT-PCR). RESULTS Nineteen of the 39 detectable genes showed a significant change in GE after surgery. Confirmed by RT-PCR, transfused MOF patients exhibit significantly less downregulation of CD40 ligand than control patients. Patients who would develop MOF show significantly larger increases in GE of transforming growth factor-α (TGF-α), tumour necrosis factor (TNF)-superfamily members 10 and 13B (TNFsf10/13B). CONCLUSIONS When tested at 24 h after surgery, cytokine GE in peripheral blood leucocytes showed no significant differences between those transfused and those not transfused. Some alterations were seen in those developing MOF compared to those who did not, but the findings offer no role of leukocyte depleted (LD) RBC transfusion in the development of MOF.
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Affiliation(s)
- L S Sitniakowsky
- Department of Transfusion Medicine, Sanquin Blood Supply, Research Division Department of Cardiothoracic Surgery, LUMC, Leiden, The Netherlands.
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Tuinman PR, Vlaar AP, Cornet AD, Hofstra JJ, Levi M, Meijers JCM, Beishuizen A, Schultz MJ, Groeneveld ABJ, Juffermans NP. Blood transfusion during cardiac surgery is associated with inflammation and coagulation in the lung: a case control study. Crit Care 2011; 15:R59. [PMID: 21314930 PMCID: PMC3221992 DOI: 10.1186/cc10032] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 01/18/2011] [Accepted: 02/11/2011] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Blood transfusion is associated with increased morbidity and mortality in cardiac surgery patients, but cause-and-effect relations remain unknown. We hypothesized that blood transfusion is associated with changes in pulmonary and systemic inflammation and coagulation occurring in patients who do not meet the clinical diagnosis of transfusion-related acute lung injury (TRALI). METHODS We performed a case control study in a mixed medical-surgical intensive care unit of a university hospital in the Netherlands. Cardiac surgery patients (n = 45) were grouped as follows: those who received no transfusion, those who received a restrictive transfusion (one two units of blood) or those who received multiple transfusions (at least five units of blood). Nondirected bronchoalveolar lavage fluid (BALF) and blood were obtained within 3 hours postoperatively. Normal distributed data were analyzed using analysis of variance and Dunnett's post hoc test. Nonparametric data were analyzed using the Kruskal-Wallis and Mann-Whitney U tests. RESULTS Restrictive transfusion increased BALF levels of interleukin (IL)-1β and D-dimer compared to nontransfused controls (P < 0.05 for all), and IL-1β levels were further enhanced by multiple transfusions (P < 0.01). BALF levels of IL-8, tumor necrosis factor α (TNFα) and thrombin-antithrombin complex (TATc) were increased after multiple transfusions (P < 0.01, P < 0.001 and P < 0.01, respectively) compared to nontransfused controls, but not after restrictive transfusions. Restrictive transfusions were associated with increased pulmonary levels of plasminogen activator inhibitor 1 compared to nontransfused controls with a further increase after multiple transfusions (P < 0.001). Concomitantly, levels of plasminogen activator activity (PAA%) were lower (P < 0.001), indicating impaired fibrinolysis. In the systemic compartment, transfusion was associated with a significant increase in levels of TNFα, TATc and PAA% (P < 0.05). CONCLUSIONS Transfusion during cardiac surgery is associated with activation of inflammation and coagulation in the pulmonary compartment of patients who do not meet TRALI criteria, an effect that was partly dose-dependent, suggesting transfusion as a mediator of acute lung injury. These pulmonary changes were accompanied by systemic derangement of coagulation.
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Affiliation(s)
- Pieter R Tuinman
- Department of Intensive Care Medicine and Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Academic Medical Center, Meibergdreef 9, Amsterdam, NL-1105 AZ, The Netherlands
| | - Alexander P Vlaar
- Department of Intensive Care Medicine and Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Academic Medical Center, Meibergdreef 9, Amsterdam, NL-1105 AZ, The Netherlands
| | - Alexander D Cornet
- Department of Intensive Care Medicine, VU University Medical Center, De Boelelaan 1117, Amsterdam, NL-1081 HZ, The Netherlands
| | - Jorrit J Hofstra
- Department of Intensive Care Medicine and Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Academic Medical Center, Meibergdreef 9, Amsterdam, NL-1105 AZ, The Netherlands
| | - Marcel Levi
- Department of Internal Medicine, Academic Medical Center, Meibergdreef 9, Amsterdam, NL-1105 AZ, The Netherlands
| | - Joost CM Meijers
- Department of Experimental Vascular Medicine, Academic Medical Center, Meibergdreef 9, Amsterdam, NL-1105 AZ, The Netherlands
| | - Albertus Beishuizen
- Department of Intensive Care Medicine, VU University Medical Center, De Boelelaan 1117, Amsterdam, NL-1081 HZ, The Netherlands
| | - Marcus J Schultz
- Department of Intensive Care Medicine and Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Academic Medical Center, Meibergdreef 9, Amsterdam, NL-1105 AZ, The Netherlands
| | - AB Johan Groeneveld
- Department of Intensive Care Medicine, VU University Medical Center, De Boelelaan 1117, Amsterdam, NL-1081 HZ, The Netherlands
| | - Nicole P Juffermans
- Department of Intensive Care Medicine and Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Academic Medical Center, Meibergdreef 9, Amsterdam, NL-1105 AZ, The Netherlands
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16
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Toraman F, Senay S, Gullu U, Karabulut H, Alhan C. Readmission to the Intensive Care Unit after Fast-Track Cardiac Surgery: An Analysis of Risk Factors and Outcome according to the Type of Operation. Heart Surg Forum 2010; 13:E212-7. [DOI: 10.1532/hsf98.20101009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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17
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Senay S, Toraman F, Karabulut H, Alhan C. Is it the patient or the physician who cannot tolerate anemia? A prospective analysis in 1854 non-transfused coronary artery surgery patients. Perfusion 2010; 24:373-80. [DOI: 10.1177/0267659109358118] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and objective: Low hematocrit level and transfusion may coexist during cardiopulmonary bypass and the actual impact of one on the outcome parameters may be counfounded or masked by the other. This study aims to determine the impact of the lowest hematocrit level during cardiopulmonary bypass on outcome parameters in non-transfused patients. Methods: Two thousand six hundred and thirty-two consecutive patients who underwent isolated coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass were evaluated prospectively:1854 (70.4%) patients who did not receive any red blood cells during hospital stay were included in the study. Perioperative data and outcome parameters were recorded. Outcomes were evaluated in 2 groups according to the lowest level of hematocrit (>21%: high hematocrit group, n= 1680, (91.6%) and ≤21%: low hematocrit group, n=174, (9.4%)) during cardiopulmonary bypass. Results: Overall mean lowest hematocrit level of patients was 27.7±4.4% (19.7±1.9% in the low hematocrit group, 28.5±4.1% in the high hematocrit group). The comparison of outcome parameters regarding the time on ventilator, duration of intensive care unit stay, intensive care unit re-admission, hospital re-admission, reoperation for bleeding or tamponade, low cardiac output, postoperative atrial fibrillation, stroke, creatinine level at hospital discharge, new onset renal failure, mediastinitis, pulmonary complication and mortality rates were similar in both groups. Conclusions: Our findings suggest that a lowest hematocrit level of ≤21% during cardiopulmonary bypass has no adverse impact on outcome after isolated coronary surgery in non-transfused patients.
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Affiliation(s)
- Sahin Senay
- Acibadem University School of Medicine, Department of Cardiovascular Surgery, Istanbul, Turkey,
| | - Fevzi Toraman
- Acibadem University School of Medicine, Department of Cardiovascular Surgery, Istanbul, Turkey
| | - Hasan Karabulut
- Acibadem University School of Medicine, Department of Cardiovascular Surgery, Istanbul, Turkey
| | - Cem Alhan
- Acibadem University School of Medicine, Department of Cardiovascular Surgery, Istanbul, Turkey
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