Depression of host-defence mechanisms following cardiac surgery

Bacterial examinations of temporary pacing wires (P-wires), pulmonary arterial (P-A) catheters, and drainage tubes temporarily inserted during open-heart surgery were performed in 213 patients. Bacteria were detected in 19 (2.8%) of 672 specimens gathered from the subject patients, with coagulase-negative Staphylococcus (CNS) being most frequently observed. P-wires accounted for 17 out of 19 of the culture-positive specimens, and 7 of the P-wires remained in place for more than two weeks. The frequency of infection with the P-wires was significantly higher than with the P-A catheters or drainage tubes. The period of time that the P-wire was left in place significantly longer than for P-A catheter or drainage tube. There was, however, no statistically significant difference between the culture-positive and negative groups in respect to age, detention periods, operation times, CPB times, or length of ICU stay. As a result of these findings, we have concluded that P-wires should be removed as soon as possible following surgery, and in any case, a meticulous care should be taken to prevent transcutaneous infection.

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Postoperative infections related to pacing wires, pulmonary Arterial catheters, and drainage tubes temporarily Inserted during open-heart surgery

Kanoh

Ishikawa

Suzuki

et al. 1998

Jpn J Thorac Caridovasc Surg

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Handwashing before entering the intensive care unit: What we learned from continuous video-camera surveillance

Nishimura

Kagehira²,

Kono³

et al. 1999

American Journal of Infection Control

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Effects of anaesthesia and surgery on the immune response

Salo

1992

Acta Anaesthesiol Scand

309

171

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Alterations have been found to occur in every component of immune response during anaesthesia and surgery. These alterations represent the body's general physiological responses and are mainly dependent on the extent of surgery, as well as other factors such as the patient's age and health status, medication and blood transfusion. Anaesthetic and operative complications have profound effects on these responses. Basically, the immune response to anaesthesia and surgery is a beneficial reaction, needed in local host defences and wound healing and in preventing the body from making autoantibodies against its own tissues. The responses may, however, contribute to the development of postoperative infections and spread of malignant disease. During uncomplicated conventional surgery, the immune response usually passes clinically unnoticed without any harmful effects. Absent responses and excessively high responses, on the other hand, harm the patient. Our understanding of immunological phenomena and our possibilities of controlling mediator activation are now lagging behind the technical advances made in operative treatment. If we want to decrease operative morbidity and mortality to below their present levels, more attention should be directed to immune responses to major surgery, injuries and operative complications with massive mediator release which place the surgical patient at risk. Experimental evidence suggests that results of treatment in injured and operated patients can in the future be improved by controlling immune responses and their mediator systems. Our current level of knowledge of immune responses is already helping us to avoid many immune-mediated complications. However, routine interference with these responses is not indicated.

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Depression of host-defence mechanisms following cardiac surgery

Cited by 4 publications

References 14 publications

Postoperative infections related to pacing wires, pulmonary Arterial catheters, and drainage tubes temporarily Inserted during open-heart surgery

Postoperative infections related to pacing wires, pulmonary Arterial catheters, and drainage tubes temporarily Inserted during open-heart surgery

Handwashing before entering the intensive care unit: What we learned from continuous video-camera surveillance

Effects of anaesthesia and surgery on the immune response

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