Acute-phase responses to cardiopulmonary bypass in children weighing less than 10 kilograms

Butler, John M.; Pathi, Vivek; Paton, Robert D.; Logan, R. W.; MacArthur, Kenneth; Jamieson, M. P. G.; Pollock, James K.

doi:10.1016/0003-4975(96)00325-6

Cited by 81 publications

(43 citation statements)

References 20 publications

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“…The inflammatory process after CPB has its final lesion characterized by an increase of diffuse capillary permeability with significant liquid extravasation towards the interstitial tissue [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] . This finding could be partially explained by the presence of what is currently called endothelial dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“…In this context, there is a stimulation of leukocytes, monocytes, macrophages, basophils, endothelial cells, myocytes and hepatocytes. There is an increase in the circulation of complement fractions (mainly C3a, C4a and C5a) 5,6 , citokynes (mainly tumor necrosis factoralpha, class 1, 6, 8 and 10 interleukins) [7][8][9] , histamine 10 and adhesion molecules 11. The inflammatory cascade is then amplified and may be associated with clinical manifestations by fever occurrences 12,13 , myocardial dysfunction (due to mechanical, ischemic and immunological injury) 14,15 and/or vasoplegy 16,17 , with occurrence of hypotension; signs of low cardiac output with hyperperfusion and tissular hypoxia; acute renal insufficiency 18,19 ; acute pulmonary lesion 20 , acute respiratory distress syndrome 21 ; blood dyscrasia 22 , neurological symptoms 23,24 and liquid retention with weight gain down to endothelial lesion 25 . When present, these manifestations may prolong the period of stay in ICU and in general hospital due to aggregated morbidity.…”

Section: Introductionmentioning

confidence: 99%

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Perfil clínico da resposta inflamatória sistêmica após cirurgia cardíaca pediátrica com circulação extracorpórea

Soares¹,

Ribas²,

Spring³

et al. 2010

Arq. Bras. Cardiol.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Perfil clínico da resposta inflamatória sistêmica após cirurgia cardíaca pediátrica com circulação extracorpórea

Soares¹,

Ribas²,

Spring³

et al. 2010

Arq. Bras. Cardiol.

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“…These proinflammatory cytokines play important roles in the pathogenesis of SIRS or post-pump syndrome [21][22][23]. Several risk factors have implicated in the accumulation of excess water such as children, long CPB duration, hypothermia and hemodilution; however, they have not been thoroughly investigated.…”

Section: Effect Of Muf On Systemic Inflammatory Responsementioning

confidence: 99%

“…Several risk factors have implicated in the accumulation of excess water such as children, long CPB duration, hypothermia and hemodilution; however, they have not been thoroughly investigated. Effects of MUF on clinical outcomes in pediatric cardiac surgery have been reported by several randomized, nonrandomized studies and meta-analysis although the results were inconclusive [1,12,14,18,[21][22][23][24][25][26][27][28][29][30][31].…”

Section: Effect Of Muf On Systemic Inflammatory Responsementioning

confidence: 99%

The effects of modified ultrafiltration on clinical outcomes of adult and pediatric cardiac surgery

et al. 2015

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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.

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“…The severity of these abnormalities can be influenced by many factors, including the type of congenital heart defect, duration of CPB and the degree of inflammatory responses resulting from the release of endotoxin and increased levels of cytokines during the CPB [4][5][6][7]. Several studies have shown that the inflammatory cytokines such as IL-6, CRP, IL-10, and IL-8 can significantly increase in infants and children after CPB [8][9][10][11] and that these increases can contribute to postoperative morbidity and mortality. It had been suggested that elevation of these proteins may be predicttive of subsequent cognitive dysfunction [12,13].…”

Section: Introductionmentioning

confidence: 99%

Granulocyte-colony stimulating factor suppresses early inflammatory response of striatum in a cardiopulmonary bypass-circulatory arrest model of ischemic brain injury in newborn piglets

Pastuszko¹,

Schears²,

Kubin³

et al. 2013

WJCD

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We investigated the effect of Granulocyte-Colony Stimulating Factor (G-CSF) on expression of pro-and anti-inflammatory proteins in the striatum of newborn piglet brain following cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA). Piglets were placed on CPB, cooled to 18˚C, subjected to 30 min of DHCA and 1 h of low-flow (20 ml/kg/min), rewarmed to 37˚C, separated from CPB circuit and monitored for 2 h. Striatum was then isolated for protein analysis. The levels of proteins are presented relative to the mean in the control group (mean ± SEM, n = 6). DHCA increased the levels of pro-inflammatory proteins: IL-1alpha (158%  23%, P = 0.05), IL-6 (152%  16%, P = 0.03), TNF-alpha (144%  2%, P = 0.003), MIP-3 alpha (148%  12.6%, P = 0.03), NAP-3 (216%  16%, P = 0.05), GRO (165%  19%, P = 0.03) and BLC (140.4  15%, P = 0.05). Compared to DHCA, the G-CSF-treated group had significantly decreased levels of IL-6 (110.8%  11% vs. 152%  16%, P = 0.05), TNF-alpha (120.6%  5.4% vs. 144%  2%, P = 0.001), MIP-3 alpha (148%  12.6% vs. 104.8%  13%, P = 0.02) and NAP-2 (216%  16% vs. 122%  23%, P = 0.002). The levels of anti-inflammatory proteins did not change in DHCA group compared to control, except for VEGF which decreased to 37.5%  9%, P = 0.003. The levels of all protective proteins in the G-CSF group increased versus the DHCA group, but the increases did not attain a P value of 0.05. Conclusions: In an immature brain subjected to circulatory arrest, the early inflammatory response in the striatum is diminished by pretreatment with G-CSF.

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Acute-phase responses to cardiopulmonary bypass in children weighing less than 10 kilograms

Cited by 81 publications

References 20 publications

Perfil clínico da resposta inflamatória sistêmica após cirurgia cardíaca pediátrica com circulação extracorpórea

Perfil clínico da resposta inflamatória sistêmica após cirurgia cardíaca pediátrica com circulação extracorpórea

The effects of modified ultrafiltration on clinical outcomes of adult and pediatric cardiac surgery

Granulocyte-colony stimulating factor suppresses early inflammatory response of striatum in a cardiopulmonary bypass-circulatory arrest model of ischemic brain injury in newborn piglets

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