Avaliação da aprotinina na redução da resposta inflamatória sistêmica em crianças operadas com circulação extracorpórea

Abstract

Avaliação da aprotinina na redução da resposta inflamatória sistêmica em crianças operadas com circulação extracorpóreaAssessment of aprotinin in the reduction of inflammatory systemic response in children undergoing surgery with cardiopulmonary bypass Abstract Objective: To assess if the hemostatic high-dose aprotinin is able to reduce the inflammatory process after cardiopulmonary bypass (CPB) in children.Methods: A prospective randomized study was performed on children aged 30 days to 4 years who underwent correction of acyanogenic congenital heart disease with CPB and were divided into two groups: Control (n=9) and Aprotinin (n=10). In the Aprotinin Group the drug was administered before and during CPB and the systemic inflammatory response and hemostatic and multiorgan dysfunctions were assessed through clinical and biochemical markers. Differences were considered to be significant when P<0.05.Results: The groups were similar regarding demographic and intraoperative variables, except for a greater hemodilution in the Aprotinin Group. The drug had no benefit regarding time of mechanical pulmonary ventilation, staying in the postoperative ICU and length of hospitalization, or regarding the use of inotropic drugs and renal function. The partial arterial oxygen pressure/ inspired oxygen fraction ratio (PaO 2 /FiO 2 ) was significantly reduced 24 h after surgery in the Control Group. Blood loss was similar for both groups. Significant leukopenia was observed in the Aprotinin Group during CPB, followed by leukocytosis. Tumor necrosis factor alpha (TNF-á), interleukins (IL)-6, IL-8, IL-10, IL-6/IL-10 ratio did not differ significantly between groups. The postoperative IL-6/IL-10 ratio increased significantly in the Control Group. There were no complications with the use of aprotinin.Conclusion: In this study, hemostatic high-dose aprotinin did not minimize the clinical manifestations or serum markers of the inflammatory systemic response. Descriptors 86FERREIRA, CA ET AL -Assessment of aprotinin in the reduction of inflammatory systemic response in children undergoing surgery with cardiopulmonary bypass Bras Cir Cardiovasc 2010; 25(1): 85-98 Rev

Clinical and functional capacity of patients with dilated cardiomyopathy after four years of transplantation

“…This limited biocompatibility of materials causes multiorgan dysfunction after systemic perfusion, expressed by myocardial depression, vasomotor dysfunction, respiratory, renal and hepatic failure, cognitive imbalance and of thermal regulation for coagulopathy for bleeding, which characterizes the SIRS. It is the cause of mortality of CPB, manifesting in different degrees and in different organs, and its greatest manifestations affecting the heart and lungs [21]. All these factors may explain the occurrence of the various postoperative complications found in this study.…”

Comparison of hypertonic saline versus normal saline on cytokine profile during CABG

“…Another work in these patients had shown the incidence of multiple organ dysfunction syndrome (MODS) following CPB was 11%, with a mortality rate of 41% [6]. Various studies have investigated different methods to reduce this vigorous inflammatory response following cardiac surgery with CPB; include perioperative administration of corticosteroids [10], aprotinin [11], statins [12], pentoxifylline [13], milrinone [14], ketamine [15], and bovine intestinal alkaline phosphatase [16]. …”