Acute respiratory distress syndrome secondary to cardiopulmonary bypass: Do compromised plasma iron-binding antioxidant protection and thiol levels influence outcome?

Quinlan, Gregory J.; Mumby, Sharon; Lamb, Nicholas J.; Moran, Louise K.; Evans, Timothy W.; Gutteridge, John M.C.

doi:10.1097/00003246-200007000-00015

Cited by 15 publications

(11 citation statements)

References 10 publications

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“…In addition to impaired fluid handling, patients with ALI are under oxidative stress, and an association between low plasma thiol concentrations and mortality rate has been shown previously (4). Plasma thiol depletion is closely related to plasma albumin concentrations and therefore nutritional status but is additionally influenced by oxidative stress (24). Moreover, the underlying illness precipitating ALI may have pro-oxidant and antioxidant affects that also influence mortality rate (24).…”

Section: Discussionmentioning

confidence: 97%

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Albumin influences total plasma antioxidant capacity favorably in patients with acute lung injury*

Quinlan

Mumby

Martin

et al. 2004

Critical Care Medicine

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178

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Section: Discussionmentioning

confidence: 97%

“…Plasma thiol depletion is closely related to plasma albumin concentrations and therefore nutritional status but is additionally influenced by oxidative stress (24). Moreover, the underlying illness precipitating ALI may have pro-oxidant and antioxidant affects that also influence mortality rate (24).…”

Section: Discussionmentioning

confidence: 99%

Albumin influences total plasma antioxidant capacity favorably in patients with acute lung injury*

Quinlan

Mumby

Martin

et al. 2004

Critical Care Medicine

Self Cite

178

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show abstract

“…Thus oxidative damage to plasma proteins and lipids is a feature of, and mortality predictor in, patients with established ARDS seen in association with a variety of conditions, including surgery necessitating CPB [31,[37][38][39]. Secondly, deficiencies in antioxidant protection against the pro-oxidant catalytic effects of iron are detectable in these patients [40,41]. Thirdly, plasma iron mobilization (indicated by increased iron-loading of transferrin) is associated significantly with the development of ALI in a population of patients with SIRS following CPB [42].…”

Section: Oxidative Stress and Critical Illnessmentioning

confidence: 99%

Redox regulation of neutrophil apoptosis and the systemic inflammatory response syndrome

2005

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SIRS (systemic inflammatory response syndrome) may result from a wide variety of non-infective insults. Surgery is a recognized cause of SIRS, the onset of which can have adverse prognostic significance. Neutrophil activation is a key histopathological feature of SIRS, and neutrophil clearance through programmed cell death or apoptosis is an essential step in its resolution. Increasingly, it is recognized that ROS (reactive oxygen species), such as those generated by activated neutrophils during cardiac surgery, may have a regulatory role, influencing neutrophil lifespan and thus inflammation. In this review, we discuss the continuing importance of SIRS as a herald of inflammation and the role of neutrophil longevity in the resolution of inflammation, and we consider recent evidence for the regulation of neutrophil apoptosis by ROS.

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“…It has been proposed that increased free radical activity represents a potential risk for acute respiratory distress syndrome (ARDS) after CPB. 16 MDA, an important decomposition product of lipid peroxides, is an indirect measure of free radical activity. 12 Increased lipid peroxidation, a marker of free oxygen radical damage, was indeed observed in our study after CPB tended to increase these products, as would be anticipated.…”

Section: Discussionmentioning

confidence: 99%

Effects of N-acetylcysteine on pulmonary function in patients undergoing coronary artery bypass surgery with cardiopulmonary bypass

et al. 2003

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Cardiopulmonary bypass (CPB) has been implicated in causing poor pulmonary gas exchange postoperatively in patients undergoing coronary artery bypass grafting (CABG) procedures. In this prospective, randomized, double-blind, placebo-controlled study, we examined the pulmonary effects of N-acetylcysteine (NAC) in patients undergoing CABG. Twenty patients undergoing elective CABG and early tracheal extubation were randomized into two groups. Group I (ten patients) received a physiologic salt solution as a placebo in a continuous intravenous infusion for one hour before CPB and 24 hours after CPB; Group II (ten patients) received 100 mg/ kg NAC intravenously for one hour before CPB and 40 mg/kg/day at 24 hours after CPB. Perioperative hemodynamic and pulmonary data were recorded. Postoperative tracheal extubation was accomplished at the earliest appropriate time. The postoperative clinical course was similar in the two groups. Both groups exhibited significant postoperative increases in A-a oxygen gradient (p < 0.01), but patients in Group II exhibited significantly lower increases in postoperative A-a oxygen gradient (p < 0.006). Other hemodynamic and pulmonary data (pulmonary capillary wedge pressure, pulmonary vascular resistance (PVR), cardiac index (CI), shunt flow, dynamic lung compliance and static lung compliance) exhibited no differences between the groups. There was no significant difference in terms of intubation time. The malondialdehyde (MDA) increase in Group II following CPB was found to be significantly lower than in Group I (p = 0.043). This clinical study reveals that administration of NAC to patients undergoing elective CABG with CPB improves systemic oxygenation. There was no effect in other pulmonary parameters and in terms of intubation time.

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Acute respiratory distress syndrome secondary to cardiopulmonary bypass: Do compromised plasma iron-binding antioxidant protection and thiol levels influence outcome?

Abstract: Increased levels of plasma thiol appear to be associated with mortality in patients with ARDS secondary to CPB surgery.

Cited by 15 publications

References 10 publications

Albumin influences total plasma antioxidant capacity favorably in patients with acute lung injury*

Albumin influences total plasma antioxidant capacity favorably in patients with acute lung injury*

Redox regulation of neutrophil apoptosis and the systemic inflammatory response syndrome

Effects of N-acetylcysteine on pulmonary function in patients undergoing coronary artery bypass surgery with cardiopulmonary bypass

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