Clinical Effectiveness of Leukocyte Filtration During Cardiopulmonary Bypass in Patients with Chronic Obstructive Pulmonary Disease

The effects of various leukocyte filtration strategies in cardiac surgery

“…Although it is indisputable that leukocyte-depleting filters do remove leukocytes from a stream of blood, they do not appear to consistently lower leukocyte concentrations within the circulation, or they do it only transiently [55,57,90]. Recognizing this, it has been claimed that any possible clinical effect of leukocyte-depleting filters may arise from their alleged propensity to preferentially remove activated leukocytes from the circulation.…”

“…Englander et al on an infant cohort found no difference between groups in the ventilation time or respiratory index [41]. In patients with chronic obstructive pulmonary disease, Karaiskos et al reported significantly better respiratory indices for 12 h after cessation of CPB [57] coupled with significantly shorter intubation times for LD patients. Likewise, in patients with mild lung dysfunction (AaOi > 1.25) Sheppard et al [62] found better AaOi ( p < 0.05) up to 8 h post CPB and a significantly shorter ventilation time in favour of leukofiltration.…”

“…Johnson et al demonstrated lower WCCs at 1, 4 and 24 h post-operatively in the filtered cohort [55] and Efstathiou et al found that both groups had significantly elevated WCCs post-operatively, but that these were significantly lower in the depleted group [56]. Karaiskos et al reported a difference between the two groups on arrival in ITU but not thereafter [57], and although Patel et al report lower WCCs 'post-operatively', they do not specify when the blood samples were taken [58].…”

“…Patel et al showed a significantly shorter length of hospital stay in the leukodepleted group ( p = 0.04) [58] whereas Karaiskos et al, whose study was on 20 chronic obstructive airways disease (COPD) sufferers, found that ITU and hospital stay were also significantly shorter in the LD group [57]. It should be stressed, though, that numerous other studies have shown no benefit in terms of duration of ITU or hospital stay [9,10,[25][26][27]41,45,46,49,50,53,56].…”

Η Επίδραση Της Στρατηγικής Περιορισμού Των Ενδοφλεβίως Χορηγούμενων Υγρών Στον Αριθμό Των Μεταγγιζόμενων Μονάδων Συμπυκνωμένων Ερυθρών Στις Καρδιοχειρουργικές Επεμβάσεις Με Εξωσωματική Κυκλοφορία

“…Αυτά τα φίλτρα είναι ικανά να εξαντλήσουν τη συστηµατική κυκλοφορία των λευκών και πιθανόν να βελτιώσουν τη λειτουργία των οργάνων µετά την επέµβαση. Βελτιωµένη προσκόλληση ουδετεροφίλων [626], καλύτερη ενδοθηλιακή λειτουργία [626] και λειτουργία των πνευµόνων [627], περιορισµό της βλάβης επαναιµάτωσης [628], µειωµένη συχνότητα κολπικής µαρµαρυγής [629] και βελτίωση της εγκεφαλικής λειτουργίας µετά από κυκλοφορική παύση [630], αποτελούν φερόµενα οφέλη που αποδίδονται στη χρήση των εξασθενηµένων λευκών στα διάφορα στάδια της CPB. Κανένα από τα παρατηρούµενα οφέλη δε µεταφράζεται σταθερά σε σηµαντικό κλινικό όφελος [631][632][633][634][635].…”