Pulmonary injury after cardiopulmonary bypass: Beneficial effects of low-frequency mechanical ventilation

Imura, Hajime; Caputo, Massimo; Lim, Kihong; Ochi, Masami; Suleiman, M‐Saadeh; Shimizu, Kazuo; Angelini, Gianni

doi:10.1016/j.jtcvs.2008.11.014

Cited by 59 publications

(43 citation statements)

References 41 publications

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“…13,14,17 The study outcomes to assess pulmonary dysfunction were prespecified secondary outcomes in these experiments, however, no power calculation was performed a priori, and our analysis should be considered exploratory.…”

Section: Discussionmentioning

confidence: 99%

Interactions of Cardiopulmonary Bypass and Erythrocyte Transfusion in the Pathogenesis of Pulmonary Dysfunction in Swine

Patel¹,

Lin²,

Jones

et al. 2013

Anesthesiology

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Background: Allogeneic erythrocyte transfusion in cardiac surgical patients is associated with a fourfold increase in pulmonary complications. Our understanding of the processes underlying these observations is poor and there is no experimental model of transfusion-related acute lung injury that shows homology to cardiac surgical patients. Our objective was to develop a novel swine recovery model to determine how two clinical risk factors, allogenic erythrocyte transfusion and cardiopulmonary bypass, interact in the genesis of postcardiac surgery acute lung injury. Methods: Thirty-six pigs were infused with allogeneic 14-or 42-day-old erythrocytes or they underwent cardiopulmonary bypass with or without transfusion of 42-day erythrocyte. Controls received saline. All pigs were recovered and assessed for pulmonary dysfunction, inflammation, and endothelial activation at 24 h. Results: Transfusion of stored allogeneic erythrocytes in pigs compared with sham caused pulmonary dysfunction characterized by reduced lung compliance (mean difference −3.36 [95% CI, −5.31 to −1.42] ml/cm H 2 O), an increase in protein levels in bronchoalveolar lavage fluid, histological lung injury inflammation, and endothelial activation. Transfusion of blood stored for up to 42 days resulted in greater protein levels in bronchoalveolar lavage fluid, macrophage infiltration, platelet activation, and depletion of T-lymphocytes in recipient lungs versus 14-day-old blood. Transfusion interacted with cardiopulmonary bypass to increase lung injury in the absence of platelet activation. Conclusions: In this novel large animal model of allogeneic erythrocyte transfusion, pulmonary dysfunction occurs in the absence of any priming event, is increased when combined with other inflammatory stimuli, and is mediated by monocyte activation and T-lymphocyte depletion. What We Already Know about This Topic• Transfusion of allogeneic erythrocytes increases the risk of pulmonary morbidity postcardiac surgery.• Using a novel in vivo porcine model of pulmonary dysfunction, this study determined whether (1) the transfusion of older erythrocytes would cause greater pulmonary dysfunction compared with younger erythrocytes; and (2) erythrocyte transfusion would interact with cardiopulmonary bypass to increase the severity of pulmonary dysfunction. What This Article Tells Us That Is New• Allogeneic erythrocyte transfusion of older erythrocytes causes pulmonary dysfunction, which is characterized by marked neutrophil/macrophage infiltration. Moreover, transfusion interacted with cardiopulmonary bypass to increase lung injury.

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Section: Discussionmentioning

confidence: 99%

Interactions of Cardiopulmonary Bypass and Erythrocyte Transfusion in the Pathogenesis of Pulmonary Dysfunction in Swine

Patel¹,

Lin²,

Jones

et al. 2013

Anesthesiology

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“…In the analysis of postoperative variables (mean and standard deviation) in order to compare the two groups, SX group showed lower loss of FVC and FEV 1 than group IC at all times (Table II). Post-operative lung function, when compared with baseline values, were analyzed and showed that the loss in FEV 1 and FVC was always lower in SX group than in IC group (Table III).…”

Section: Resultsmentioning

confidence: 99%

“…Change in lung function increases morbidity and mortality in coronary artery bypass grafting 1 . Several factors contribute to this, such as median sternotomy, cardiopulmonary bypass 2,3 , pleurectomy, and postoperative pain 4 .…”

Section: Introductionmentioning

confidence: 99%

Influência da posição do dreno pleural na função pulmonar de pacientes submetidos à revascularização do miocárdio

Vieira¹,

Vieira²,

Abrão

et al. 2012

Rev. Bras. Anestesiol.

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Summary: Ozelami Vieira IBC, Vieira FF, Abrão J, Gastaldi AC -Influence of Pleural Drain Insertion in Lung Function of Patients Undergoing Coronary Artery Bypass Grafting. Background and objectives:Longitudinal, prospective, randomized, blinded Trial to assess the influence of pleural drain (non-toxic PVC) site of insertion on lung function and postoperative pain of patients undergoing coronary artery bypass grafting in the first three days post-surgery and immediately after chest tube removal.

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“…Cross-clamping the aorta and infusion of cardioplegic solutions render the heart (and the lungs) ischemic [1][2][3]. The addition of large volume of pump prime to the patient's circulation at the beginning of CPB decreases arterial oxygen content causing the release vasoconstrictors and therefore results in reduced oxygen delivery to peripheral (e.g.…”

Section: Introductionmentioning

confidence: 99%

Source, Triggers and Clinical Implications of Hyperlactemia in Patients Undergoing Mitral Valve Surgery Using Custodiol Cardioplegia

Ascione¹,

Venturini²,

Polesel³

et al. 2013

WJCS

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Background: Postoperative blood hyperlactaemia is an indicator of organ anaerobic metabolism and is associated with morbidity after cardiac surgery. This prospective study aims to explore the source, triggers and clinical implications for hyperlactaemia in patients undergoing mitral valve surgery using Custodiol cardioplegia. Methods: Twenty consecutive elective patients undergoing open-heart surgery for mitral valve repair/replacement using Custodiol (based on Bretschneider's HTK-solution) cardioplegia were recruited. A serial measurement of arterial blood lactate was performed. Pre-, intra-and post-operative clinical data were obtained and cardiac injury was determined by serial plasma measurement of postoperative release of CK-MB. Results: There were no in-hospital deaths. Most of the patients (n = 16) needed intraoperative direct current cardioversion to treat ventricular arrhythmias or post-operative vasopressors (n = 13) to treat vasoplegia. There was significant cardiac injury as determined by the marked increase of serum CK-MB (p < 0.05). A significant (p < 0.05) increase in blood lactate was found to follow a biphasic profile. The first peak (from 0.54 ± 0.03 to 1.3 ± 0.07 mM) was observed immediately following the release of the aortic cross-clamp and remained high for 1 hour. This was followed by a second peak at 12 hours postoperatively (1.9 ± 0.2 mM). The second rise in lactate was seen only in patients that required post-operative vasopressors (1.3 ± 0.2 vs 2.2 ± 0.3 mM, p < 0.05), in whom a significant late decrease in CVP was also observed (12.2 ± 1.0 to 7.7 ± 1.0 for 1 and 12 hours postoperative, respectively). Hyperlactaemia did not correlate with any other variables including CK-MB levels, cross-clamp or cardiopulmonary bypass time. Conclusions: In patients undergoing mitral valve surgery with Custodiol cardioplegia there is marked cardiac injury and a biphasic release of blood lactate. The initial peak in lactate occurs immediately following unclamping the aorta and is likely to be of organ (e.g. heart and lungs) origin. A second peak is only seen in patients requiring postoperative vasopressors to treat vasoplegia. Hyperlactaemia following mitral valve surgery with Custodiol cardioplegia does not seem to be related to myocardial injury as expressed by CK-MB release.

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Pulmonary injury after cardiopulmonary bypass: Beneficial effects of low-frequency mechanical ventilation

Abstract: Low-frequency ventilation during cardiopulmonary bypass in a pig experimental model reduces tissue metabolic and histologic damage in the lungs and is associated with improved postoperative gas exchange.

Cited by 59 publications

References 41 publications

Interactions of Cardiopulmonary Bypass and Erythrocyte Transfusion in the Pathogenesis of Pulmonary Dysfunction in Swine

Interactions of Cardiopulmonary Bypass and Erythrocyte Transfusion in the Pathogenesis of Pulmonary Dysfunction in Swine

Influência da posição do dreno pleural na função pulmonar de pacientes submetidos à revascularização do miocárdio

Source, Triggers and Clinical Implications of Hyperlactemia in Patients Undergoing Mitral Valve Surgery Using Custodiol Cardioplegia

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