Cardiopulmonary Bypass and Inflammation: The Hidden Enemy

Aljure, Oscar; Fabbro, Michael

doi:10.1053/j.jvca.2018.05.030

Cited by 29 publications

(24 citation statements)

References 23 publications

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“…Maintenance of a normal COP suppresses vascular hyperpermeability, further reducing damage to the endothelial glycocalyx layer. Recently, some papers have reported that CPB-induced inflammation is associated with glycocalyx degradation [44]. HES 130/0.4 has the potential to improve organ tissue microcirculation.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Inflammation Caused by Cardiopulmonary Bypass in a Small Animal Model

Fujii

2020

Biology

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Extracorporeal circulation (ECC) methods are being increasingly used for mechanical support of respiratory and cardio-circulatory failure. Especially, cardiopulmonary bypass (CPB) during cardiovascular surgery, sustenance of the patient’s life by providing an appropriate blood flow and oxygen supply to principal organs. On the other hand, systemic inflammatory responses in patients undergoing cardiovascular surgery supported by CPB contribute significantly to CPB-associated mortality and morbidity. Our previous research showed that CPB causes a systemic inflammatory response and organ damage in a small animal CPB model. We have been studying the effects of hyperoxia and blood plasma substitute on CPB. In this review, we present a study focusing on the systemic inflammatory response during CPB, along with our findings.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Inflammation Caused by Cardiopulmonary Bypass in a Small Animal Model

Fujii

2020

Biology

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“…Conversely, there are modifiable factors in the intraoperative and postoperative periods that can be optimized to help minimize the risk of ARDS development. Direct surgical injury 13 (eg, pleural opening and use of retractors and lung manipulation) and the use of cardiopulmonary bypass (CPB) 14 commonly are encountered as intraoperative factors that trigger inflammation at the pulmonary level. In parallel, both surgical and perfusion strategies to decrease perioperative lung damage have been developed (eg, minimally invasive surgery 15 and use of miniaturized CPB circuits 16 ).…”

Section: Current Knowledge and Gaps Regarding Ards In Cardiac Surgerymentioning

confidence: 99%

Acute Respiratory Distress Syndrome in the Perioperative Period of Cardiac Surgery: Predictors, Diagnosis, Prognosis, Management Options, and Future Directions

Sanfilippo

Palumbo

Bignami

et al. 2022

Journal of Cardiothoracic and Vascular Anesthesia

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Acute respiratory distress syndrome (ARDS) after cardiac surgery is reported with a widely variable incidence (from 0.4%-8.1%). Cardiac surgery patients usually are affected by several comorbidities, and the development of ARDS significantly affects their prognosis. Herein, evidence regarding the current knowledge in the field of ARDS in cardiac surgery is summarized and is followed by a discussion on therapeutic strategies, with consideration of the peculiar aspects of ARDS after cardiac surgery. Prevention of lung injury during and after cardiac surgery remains pivotal. Blood product transfusions should be limited to minimize the risk, among others, of lung injury. Open lung ventilation strategy (ventilation during cardiopulmonary bypass, recruitment maneuvers, and the use of moderate positive end-expiratory pressure) has not shown clear benefits on clinical outcomes. Clinicians in the intraoperative and postoperative ventilatory settings carefully should consider the effect of mechanical ventilation on cardiac function (in particular the right ventricle). Driving pressure should be kept as low as possible, with low tidal volumes (on predicted body weight) and optimal positive end-expiratory pressure. Regarding the therapeutic options, management of ARDS after cardiac surgery challenges the common approach. For instance, prone positioning may not be easily applicable after cardiac surgery. In patients who develop ARDS after cardiac surgery, extracorporeal techniques may be a valid choice in experienced hands. The use of neuromuscular blockade and inhaled nitric oxide can be considered on a case-by-case basis, whereas the use of aggressive lung recruitment and oscillatory ventilation should be discouraged.

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“…This process, and the accompanying ischemia-reperfusion, can damage the coronary endothelium that may have detrimental effects on postoperative cardiac function [59,[63][64][65][66][67][68][69] . Moreover, endothelial injury extends far beyond the coronary circulation alone; the vascular beds of many organ systems, including the pulmonary and mesenteric circulations, sustain damage following CP/CPB [70][71][72] .…”

Section: Endothelial Dysfunction and Cardioplegia/cardiopulmonary Bypassmentioning

confidence: 99%

Microvascular dysfunction following cardioplegic arrest and cardiopulmonary bypass

Feng¹,

Kant²,

Sellke³

2021

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Cardioplegia and cardiopulmonary bypass (CP/CPB) during cardiac surgery may cause systemic microvascular dysfunction. CP/CPB is associated with significant alterations in myogenic tone, agonist-induced vasomotor response, and endothelial function in various organs and vascular beds. These alterations can result in vessel spasm, organ malperfusion, and tissue damage. This review summarizes the current state of research in this field.

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Cardiopulmonary Bypass and Inflammation: The Hidden Enemy

Cited by 29 publications

References 23 publications

Evaluation of Inflammation Caused by Cardiopulmonary Bypass in a Small Animal Model

Evaluation of Inflammation Caused by Cardiopulmonary Bypass in a Small Animal Model

Acute Respiratory Distress Syndrome in the Perioperative Period of Cardiac Surgery: Predictors, Diagnosis, Prognosis, Management Options, and Future Directions

Microvascular dysfunction following cardioplegic arrest and cardiopulmonary bypass

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