Acute Lung Injury During Cardiopulmonary Bypass

Tönz, Martin; Mihaljević, Tomislav; Segesser, Ludwig K. von; Turina, Marko; Fehr, J; Schmid, Edith R.

doi:10.1378/chest.108.6.1551

Cited by 129 publications

(62 citation statements)

References 26 publications

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“…[5][6][7][8][9] Multiple investigators have demonstrated large numbers of neutrophils sequestered in the lung during both ARDS 6 and postpump syndrome. 5,[7][8][9] The local cytokine activity serves to activate sequestered neutrophils, which then secrete numerous mediators. These neutrophilderived bioactive lipids, cytokines, oxygen metabolites, and granular enzymes all have the capability of injuring basement membranes and the extracellular matrix.…”

Section: Discussionmentioning

confidence: 99%

“…5 A short period of CPB alone is rather innocuous, but when it is combined with a subsequent, seemingly benign insult (ie, transient hypoxia, ischemia, endotoxemia), the result is an overwhelming inflammatory response leading to endothelial injury, pulmonary edema, and ARDS. It has been well documented that the lung injury in both ARDS 6,7 and specifically postpump syndrome [7][8][9] is neutrophil-mediated. Our previous investigations support this concept, because we have shown an association between pulmonary neutrophil sequestration and physiological lung injury.…”

Section: See P 333mentioning

confidence: 99%

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Matrix Metalloproteinase Inhibitor Prevents Acute Lung Injury After Cardiopulmonary Bypass

Carney¹,

Lutz²,

Picone³

et al. 1999

Circulation

119

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Background-Acute lung injury (ALI) after cardiopulmonary bypass (CPB) results from sequential priming and activation of neutrophils. Activated neutrophils release neutral serine, elastase, and matrix metalloproteinases (MMPs) and oxygen radical species, which damage alveolar-capillary basement membranes and the extracellular matrix, resulting in an ALI clinically defined as adult respiratory distress syndrome (ARDS). We hypothesized that treatment with a potent MMP and elastase inhibitor, a chemically modified tetracycline (CMT-3), would prevent ALI in our sequential insult model of ALI after CPB. Methods and Results-Anesthetized Yorkshire pigs were randomized to 1 of 5 groups: control (nϭ3); CPB (nϭ5), femoral-femoral hypothermic bypass for 1 hour; LPS (nϭ7), sham bypass followed by infusion of low-dose Escherichia coli lipopolysaccharide (LPS; 1 g/kg); CPBϩLPS (nϭ6), both insults; and CPBϩLPSϩCMT-3 (nϭ5), both insults plus intravenous CMT-3 dosed to obtain a 25-mol/L blood concentration. CPBϩLPS caused severe lung injury, as demonstrated by a significant fall in PaO 2 and an increase in intrapulmonary shunt compared with all groups (PϽ0.05). These changes were associated with significant pulmonary infiltration of neutrophils and an increase in elastase and MMP-9 activity. Conclusions-All pathological changes typical of ALI after CPB were prevented by CMT-3. Prevention of lung dysfunction followed an attenuation of both elastase and MMP-2 activity. This study suggests that strategies to combat ARDS should target terminal neutrophil effectors. (Circulation. 1999;100:400-406.)

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Section: Discussionmentioning

confidence: 99%

Section: See P 333mentioning

confidence: 99%

Matrix Metalloproteinase Inhibitor Prevents Acute Lung Injury After Cardiopulmonary Bypass

Carney¹,

Lutz²,

Picone³

et al. 1999

Circulation

119

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“…Penelitian Tonz dkk. 20 menyatakan terdapat korelasi positif antara konsentrasi plasma elastase (pengukur aktivasi neutrofil) dan indeks respirasi serta pintas intrapulmoner. Produk dari lipid peroksidasi dinilai dari reaksi asam tiobarbiturat yang mencapai puncak setelah klem aorta dilepas.…”

unclassified

Korelasi antara Lama Pintas Jantung Paru dan Lama Bantuan Ventilasi Mekanis pada Pasien Pascabedah Pintas Arteri Koroner di Unit Perawatan Intensif Jantung Rumah Sakit Dr. Hasan Sadikin Bandung

Setiari¹,

Sudjud²,

Redjeki³

2017

jap

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AbstrakPintas jantung paru (PJP) diperlukan untuk sebagian besar prosedur bedah pintas arteri koroner (BPAK). Fungsi paru dan oksigenasi menurun sekitar 2-90% pada pasien pascabedah jantung dengan PJP. Ketergantungan terhadap ventilator setelah BPAK secara signifikan berhubungan dengan morbiditas dan mortalitas. Tujuan penelitian ini adalah mengorelasikan waktu PJP dengan lama bantuan ventilasi mekanis pada pasien BPAK. Penelitian ini merupakan analisis kohort retorospektif pada 43 pasien yang menjalani BPAK dengan PJP yang dirawat di Unit Perawatan Intensif Jantung RSUP Dr. Hasan Sadikin Bandung pada bulan Januari 2014 sampai Juni 2015. Lama PJP dibagi menjadi ≤90 menit dan >90. Lama bantuan ventilasi mekanis terbagi menjadi ≤12 jam dan >12 jam. Parameter yang dicatat pada penelitian ini adalah usia, berat badan, tinggi badan, indeks massa tubuh, lama PJP, waktu klem aorta, dan lama bantuan ventilasi mekanis. Analisis stastistik menggunakan uji korelasi Lambda, signifikan jika nilai p<0,05. Penelitian ini menunjukkan korelasi yang cukup kuat antara waktu PJP dan lama bantuan ventilasi mekanis setelah BPAK dengan korelasi positif (0,545) dan signifikan (p<0,05). Simpulan penelitian ini adalah semakin lama waktu PJP berkorelasi dengan memanjangnya lama bantuan ventilasi mekanis. Lung functions and oxygenation are impaired in 20% to 90% of CPB cardiac surgery patients. Ventilator dependency following CABG is often associated with significant morbidity and mortality. This study aimed to correlate the CPB time and mechanical ventilation duration after coronary artery bypass graft. This was a retrospective analysis cohort study on 43 consecutive patients undergoing CABG on CPB admitted to cardiac intensive care unit between January 2014 and June 2015 in Dr. Hasan Sadikin General Hospital Bandung. The CPB time was divided into <90 minutes and ≥90 minutes. Duration of mechanical ventilation was defined as ≤12 hours and ≥12 hours of ventilation. Parameters recorded in this study were age, weight, height, body mass index, CPB time, aortic cross-clamp time, and mechanical ventilation duration. Statistical analysis was performed using Lambda correlation, which is significant if p value <0.05. This study showed moderate correlation between CPB time and mechanical ventilation duration after CABG surgery with a positive (0.545) and significant correlation (p<0.05). Conclusion of this research is longer CPB time correlates with prolonged mechanical ventilation

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“…An important role for inflammatory cells, specifically neutrophil sequestration and activation, is suggested by a number of experimental and clinical observations. [3][4][5][6][7] It has been suggested that CPB primes the neutrophils, causing their sequestration in the pulmonary microvasculature, with subsequent activation resulting in the release of tissuedestructive mediators. Several cytokines, such as interleukin-1, interleukin-6, interleukin-8, tumor necrosis factor-␣, and leukemia inhibitory factor, have been implicated in neutrophil recruitment or activation in ARDS.…”

mentioning

confidence: 99%

“…6,8 -14 Among various mediators of tissue injury released by activated neutrophils, serine proteases such as elastase and matrix-degrading metalloproteinases have been considered to be most relevant in ARDS. [3][4][5][6][7]15,16 Experimental observations suggest that neutrophil elastase may serve as an activator of gelatinase B (matrix metalloproteinase [MMP]-9). 17 Both elastase and metalloproteinases, when activated, can induce breakdown of extracellular matrix components such as elastin and basement membrane collagen type IV, resulting in microvascular endothelial damage and increased permeability.…”

mentioning

confidence: 99%

Targeting the Proteolytic Arsenal of Neutrophils

Shah

1999

Circulation

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Acute Lung Injury During Cardiopulmonary Bypass

Cited by 129 publications

References 26 publications

Matrix Metalloproteinase Inhibitor Prevents Acute Lung Injury After Cardiopulmonary Bypass

Matrix Metalloproteinase Inhibitor Prevents Acute Lung Injury After Cardiopulmonary Bypass

Korelasi antara Lama Pintas Jantung Paru dan Lama Bantuan Ventilasi Mekanis pada Pasien Pascabedah Pintas Arteri Koroner di Unit Perawatan Intensif Jantung Rumah Sakit Dr. Hasan Sadikin Bandung

Targeting the Proteolytic Arsenal of Neutrophils

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