Bronchial microdialysis monitoring of inflammatory response in open abdominal aortic aneurysm repair; an observational study

Abstract

Aortic surgery results in ischemia–reperfusion injury that induces an inflammatory response and frequent complications. The magnitude of the inflammatory response in blood and bronchi may be associated with the risk of immediate complications. The purpose of the study was to evaluate bronchial microdialysis as a continuous monitoring of cytokines in bronchial epithelial lining fluid (ELF) and to determine whether bronchial ELF cytokine levels reflect the ischemia–reperfusion injury and risk for complications during open abdominal aortic aneurysm (AAA) repair. We measured cytokines in venous blood using microdialysis and in serum for comparison. Sixteen patients scheduled for elective open AAA repair were included in a prospective observational study. Microdialysis catheters were introduced into a bronchi and a cubital vein. Eighteen cytokines were measured using a Bio‐Plex Magnetic Human Cytokine Panel. Samples were collected before and during cross‐clamping of the aorta as well as from 0 to 60 min and from 60 to 120 min of reperfusion. The ELF levels of several cytokines changed significantly during reperfusion. In particular, IL‐6 increased more than 10‐fold and IL‐13 more than 5‐fold during ischemia and reperfusion. Also, the venous levels of several inflammatory and anti‐inflammatory cytokines increased and exhibited their highest concentration during reperfusion. Both bronchial and venous cytokine levels correlated with duration of the procedure, intensive care days, and preoperative kidney disease. Three patients suffered organ failure as a direct consequence of the procedure, and in these patients the bronchial ELF concentrations of 17 of 18 cytokines differed significantly from patients without such complications. Bronchial microdialysis is suited for continuous monitoring of inflammation during open AAA repair. The bronchial ELF cytokine levels may be useful in predicting immediate complications such as organ failure in patients undergoing vascular surgery.

Feasibility of pleural and perilesional subcutaneous microdialysis to assess porcine experimental pulmonary contusion

“…25 Bronchial microdialysis displays altered levels of cytokines after intestinal ischemia reperfusion 10 and identified organ failure after open abdominal aortic aneurysm repair. 24 We show that it was possible to quantify cytokines in pleural fluid after pulmonary trauma, and that individual temporal responses and dissimilar concentrations in the bronchoalveolar lavage and pleural fluid were detected.…”

“…IL-1b, IL-6 and IL-8 are induced in ALI and ARDS and associated with multiple traumatic injuries. 1,[20][21][22][23][24] Cytokines and lung function are interrelated. In ex vivo lung perfusion, cytokine filtration reduced glucose consumption, lactate production, and the lactate/pyruvate ratio decreased edema formation.…”

Local Postoperative Graft Inflammation in Pancreas Transplant Patients With Early Graft Thrombosis

“…17 Microdialysis has also been used to investigate local tissue inflammation in several other organs. [18][19][20] In liver transplantation, patterns of local inflammatory mediators have distinguished grafts with early postoperative ischemia from those with rejections or no complications. 21,22 Our main aim was to assess the local inflammatory pattern at the pancreas grafts in patients with no early complications compared with patients developing graft thrombosis during the first postoperative week and on the day of thrombosis diagnosis.…”

“… 17 Microdialysis has also been used to investigate local tissue inflammation in several other organs. 18 - 20 In liver transplantation, patterns of local inflammatory mediators have distinguished grafts with early postoperative ischemia from those with rejections or no complications. 21 , 22 …”