Does the use of leucocyte depletion during cardiopulmonary bypass affect                 exhaled nitric oxide production?

Sheppard, S. V.; Gibbs, Roslyn V.; Smith, D.C.

doi:10.1191/0267659104pf703oa

Cited by 11 publications

(15 citation statements)

References 19 publications

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“…Chen et al reported a significantly better oxygenation index at 10 h in filtered patients, but this was not mirrored in a shorter intubation period. Sheppard et al [60] and Alexiou et al [61] used exhaled nitric oxide (NO) as a marker of lung inflammation and demonstrated a statistically significant attenuation in the post CPB rise in exhaled NO (from the preoperative baseline) in the LD group ( p = 0.002 and p = 0.02, respectively). Although neither published clinical outcomes, in further studies Alexiou et al did not identify any clinical advantage of LD despite demonstrating much better Alveolar arterial Oxygenation indices in the first 18 h post-operatively in the LD group [53].…”

Section: Pulmonary Function Palanzo Et Al Reported Bettermentioning

confidence: 99%

The effects of various leukocyte filtration strategies in cardiac surgery

Warren

Alexiou

Massey

et al. 2007

European Journal of Cardio-Thoracic Surgery

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It is known that cardiopulmonary bypass causes an inflammatory reaction with an associated morbidity and mortality. Several anti-inflammatory strategies have been implemented to reduce this response, including leukocyte removal from the circulation using specialised filters. The aim of this study is to systematically review the available evidence on leukocyte filtration in cardiac surgery, focusing on its effect on systemic inflammation and whether this has influenced clinical outcomes. Five electronic databases were systematically searched for studies reporting the effect of leukocyte filtration at any point within the cardiopulmonary bypass circuit in humans. Reference lists of all identified studies were checked for any missing publications. Two authors independently extracted the data from the included studies. Whilst systemic leukodepleting filters do not appear to consistently lower leukocyte counts, they may preferentially remove activated leukocytes. Small improvements in early post-operative lung function in patients receiving systemic leukodepletion have been reported, but this does not lead to reduced hospital stay or decreased mortality. There is substantial evidence that cardioplegic leukocyte filtration attenuates the reperfusion injury at a cellular level, but this has not been translated into clinical improvements. Finally, whilst various strategies involving multiple leukocyte filters, or the incorporation of pharmacological agents into leukocyte-depleting protocols have been evaluated, the current available results are not conclusive. Our study suggests that there is not enough high quality or consistent evidence to draw guidelines regarding the use of leukocyte-depleting filters within routine cardiac surgical practice.

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Section: Pulmonary Function Palanzo Et Al Reported Bettermentioning

confidence: 99%

The effects of various leukocyte filtration strategies in cardiac surgery

Warren

Alexiou

Massey

et al. 2007

European Journal of Cardio-Thoracic Surgery

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“…Systemic leukofiltration had no effect on postoperative respiratory infection (OR, 1.06; 95% CI, 0.39 -2.91; p ϭ 0.90). There was a 48 2 7 Mihaljevic et al 37 1 5 Hachida et al 50 1 5 Lust et al 52 3 6 Di Salvo et al 51 1 8 Hurst et al 49 2 8 Baksass et al 53 1 8 Mair et al 36 1 6 Sahlman et al 54 1 1 1 Fabbri et al 35 1 9 Stefanou et al 58 1 1 0 Efstathiou et al 39 1 8 Sheppard et al 57 2 6 Alexiou et al 56 2 1 1 Karaiskos et al 55 1 1 2 Chen et al 63 2 7 Alexiou et al 59 2 1 2 Sheppard et al 60 1 6 Leal-Noval et al 62 2 1 0 Koskenkari et al 61 1 1 0 (Figure 4) within the treatment group although neither of these was statistically significant.…”

Section: Results From Overall Meta-analysismentioning

confidence: 99%

“…Eight of the studies are doubleblind, 39,48,49,52,55,57,60,61 and the remaining ones are singleblind randomized controlled trials. Table 2 shows the number of matching criteria and the JADAD score for the randomized control trials.…”

Section: Eligible Studiesmentioning

confidence: 99%

“…Thirteen of the studies matched control and treatment groups for eight or more demographic criteria. 24,35,39,49,51,[53][54][55][56][57][58][59]61,62 The mean JADAD score was 1.43 (range, 1-3), but only eight of the studies scored higher than 1, 48,49,52,56,57,59,62,63 suggesting the overall quality of studies to be relatively poor. Table 3 demonstrates the different outcome measures reported in the 21 studies included in our analysis.…”

Section: Eligible Studiesmentioning

confidence: 99%

“…A sensitivity analysis was performed looking at studies that included Ն25 patients in both the control group and the leukofiltration group. Only 7 of our 21 studies were large enough to be considered 39,52,54,56,57,59,62 ; only one of these reported "Late" PaO 2 /FiO 2 ratio, 54 and thus, sensitivity analysis for this outcome was not possible. In this subgroup analysis, systemic leukofiltration had no effect on any of the reported outcomes.…”

Section: Sensitivity Analysismentioning

confidence: 99%

See 2 more Smart Citations

Systemic Leukofiltration Does Not Attenuate Pulmonary Injury after Cardiopulmonary Bypass

et al. 2008

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Pulmonary injury mediated by activated leukocytes is a recognized complication of cardiopulmonary bypass. The aim of this paper is to systematically analyze the effects of systemic leukofiltration within the cardiopulmonary bypass circuit on pulmonary injury and related clinical outcomes. We performed a systematic search to identify randomized controlled trials reporting on the effects of systemic leukofiltration on respiratory parameters. Random effect meta-analytical techniques were applied to identify differences in outcomes between the two groups. Sensitivity and subgroup analyses were undertaken to evaluate study heterogeneity. Incorporating 995 patients, 21 studies satisfied the inclusion criteria. Systemic leukofiltration significantly increased the PaO2/FiO2 ratio within 12 hours of bypass cessation, (weighted mean difference (WMD), 25.97; 95% confidence interval (CI), 3.41-48.53; p = 0.02) but this effect was lost by 24 hours (WMD, 12.98; 95% CI, -7.93-33.89; p = 0.22). Leukofiltration significantly reduced the duration of ventilatory support postoperatively (WMD, -2.11 hours; 95% CI, -0.65 to -3.58; p = 0.005), but had no impact on postoperative chest infection, intensive care length of stay or hospital length of stay. The heterogeneity of the included studies was high, due to poor quality study design and failure to include patients at high risk of pulmonary complications. Systemic leukofiltration may attenuate bypass-related lung injury in the early postoperative period, but this does not seem to translate to clinically significant differences in outcomes.

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Leukocyte Depletion During CPB: Effects on Inflammation and Lung Function

et al. 2013

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Cardiopulmonary bypass (CPB) is related to inflammatory response and pulmonary dysfunction. The aim of this study was to evaluate the effects of CPB leukocyte filtration on inflammation and lung function after coronary artery bypass grafting (CABG). A prospective randomized study was performed to compare CABG patients undergoing CPB leukocyte filtration (n = 9) or standard CPB (n = 11). Computed tomography, oxygenation, leukocyte count, hemodynamic data, PaO2/FiO2, shunt fraction, interleukins, elastase, and myeloperoxidase were evaluated. Data were analyzed using two-factor ANOVA for repeated measurements. The filtered group showed lower neutrophil counts up to 50 min of CPB, lower shunt fraction up to 6 h after surgery, and lower levels of IL-10 at the end of surgery (p < 0.05). There was no statistically significant difference between groups related to other parameters. Leukodepletion during CPB results in neutrophil sequestration by a short time, decreased IL-10 serum levels, and lower worsening of lung function only temporarily.

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Does the use of leucocyte depletion during cardiopulmonary bypass affect exhaled nitric oxide production?

Cited by 11 publications

References 19 publications

The effects of various leukocyte filtration strategies in cardiac surgery

The effects of various leukocyte filtration strategies in cardiac surgery

Systemic Leukofiltration Does Not Attenuate Pulmonary Injury after Cardiopulmonary Bypass

Leukocyte Depletion During CPB: Effects on Inflammation and Lung Function

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