Rosuvastatin Lowers Systemic Inflammatory Response in Coronary Artery Bypass Graft Accompanied by Cardiopulmonary Bypass Surgery: 
A Randomized Controlled Study

Özgüler, İbrahim Murat; Burma, Oktay; Uysal, Ayhan; Akbulut, Handan

doi:10.25011/cim.v38i4.24260

Cited by 14 publications

(8 citation statements)

References 41 publications

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“…Preoperative statin therapy was associated with a reduction in post-CPB inflammation [95, 96] and an improvement in morbidity and mortality after cardiac surgery [97–99]. However, a recent meta-analysis of randomized control trials (RCTs) found no evidence of benefit for patients’ outcomes [100].…”

Section: Clinical Implications Of Ecls-associated Inflammatory Responsementioning

confidence: 99%

Extracorporeal life support and systemic inflammation

Al‐Fares

Pettenuzzo

Sorbo

2019

ICMx

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Extracorporeal life support (ECLS) encompasses a wide range of extracorporeal modalities that offer short- and intermediate-term mechanical support to the failing heart or lung. Apart from the daily use of cardiopulmonary bypass (CPB) in the operating room, there has been a resurgence of interest and utilization of veno-arterial and veno-venous extracorporeal membrane oxygenation (VA- and VV-ECMO, respectively) and extracorporeal carbon dioxide removal (ECCO 2 R) in recent years. This might be attributed to the advancement in technology, nonetheless the morbidity and mortality associated with the clinical application of this technology is still significant. The initiation of ECLS triggers a systemic inflammatory response, which involves the activation of the coagulation cascade, complement systems, endothelial cells, leukocytes, and platelets, thus potentially contributing to morbidity and mortality. This is due to the release of cytokines and other biomarkers of inflammation, which have been associated with multiorgan dysfunction. On the other hand, ECLS can be utilized as a therapy to halt the inflammatory response associated with critical illness and ICU therapeutic intervention, such as facilitating ultra-protective mechanical ventilation. In addition to addressing the impact on outcome of the relationship between inflammation and ECLS, two different but complementary pathophysiological perspectives will be developed in this review: ECLS as the cause of inflammation and ECLS as the treatment of inflammation. This framework may be useful in guiding the development of novel therapeutic strategies to improve the outcome of critical illness.

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Section: Clinical Implications Of Ecls-associated Inflammatory Responsementioning

confidence: 99%

Extracorporeal life support and systemic inflammation

Al‐Fares

Pettenuzzo

Sorbo

2019

ICMx

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“…The qualitative and quantitative changes in alveolar surfactant of patients with ARDS have been proven [7][8][9]. Similarly, due to endothelial cells damage, all post-cardiac surgery infants who had ARDS suffered surfactant dysfunction, destruction and inactivation [10][11][12]. Yet, limited study [13] showed preliminary therapeutic effect of surfactant therapy on these patients, especially, the association between age or drug dose and the e cacy of surfactant therapy.…”

Section: Introductionmentioning

confidence: 99%

Effect of low-dose exogenous surfactant on infants with acute respiratory distress syndrome after cardiac surgery: A retrospective analysis

Zhang

Wang

et al. 2020

Preprint

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Background: Acute respiratory distress syndrome (ARDS) in infants undergoing cardiac surgery is associated with significant mortality and prolonged ventilation; surfactant administration may be a useful therapy. The purpose of this study was to evaluate the effect of low-dose exogenous surfactant therapy on infants suffering ARDS after cardiac surgery. Methods: We conducted a case-control study of infants diagnosed with moderate-to-severe ARDS (PaO 2 /FiO 2 < 150) after cardiac surgery. A case was defined as a patient that received surfactant and standard therapy, while a control was defined as a patient that underwent standard therapy. The primary endpoint was the improvement in oxygenation index (OI) after 24-hour of surfactant treatment; and secondary endpoints were the ventilator time and PICU time. Results: Twenty-two infants treated with surfactant were matched with 22 controls. Early low-dose (20mg/kg) surfactant treatment was associated with improved outcomes. After surfactant administration for 24-hour, the surfactant group was much better compared with the control group at the 24-hour in OI (difference in average change from baseline, -6.7 [95% CI, -9.3 to -4.1]) ( P < 0.01) and ventilation index (VI, mean difference, -11.9 [95% CI, -18.1 to -5.7]) ( P < 0.01). Ventilation time and PICU time were significantly shorter in the surfactant group compared with the control group (133.6h±27.2 vs 218.4h±28.7, P < 0.01 ; 10.7d±5.1 vs 17.5d±6.8, P < 0.01). Infants in the surfactant group under 3 months benefit more from OI and VI than the infants over 3 months in a preliminary exploratory analysis. Conclusions: In infants with moderate-to-severe ARDS after cardiac surgery, early low-dose exogenous surfactant treatment could prominently improve oxygenation and reduce mechanical ventilation time and PICU time. Infants younger than 3 months may get more benefit of oxygenation than the older ones. Randomized controlled trials are needed to explore the effect of surfactant to ARDS of cardiac surgical infants.

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“…The qualitative and quantitative changes in alveolar surfactant of patients with ARDS have been proven [6][7][8]. Similarly, due to endothelial cells damage, all post-cardiac surgery infants who had ARDS suffered surfactant dysfunction, destruction and inactivation [9][10][11]. Yet, limited study [12] showed preliminary therapeutic effect of surfactant therapy on these patients, especially, the association between age or drug dose and the efficacy of surfactant therapy.…”

Section: Introductionmentioning

confidence: 99%

Effect of low-dose exogenous surfactant on infants with acute respiratory distress syndrome after cardiac surgery: A retrospective analysis

Zhang

Wang

et al. 2020

Preprint

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Purpose: To evaluate the effect of low-dose exogenous surfactant therapy on infants suffering acute respiratory distress syndrome (ARDS) after cardiac surgery. Materials and methods: We conducted a retrospective case-control study of the archive data of infants diagnosed with ARDS after cardiac surgery and admitted to pediatric cardiac surgical intensive care unit (PICU). A case was defined as a patient that received surfactant and standard therapy; a control was defined as a patient that underwent standard therapy. Controls were identified by matching patients based on age(±30d), weight(±3kg), risk adjustment congenital heart surgery-1 (RACHS-1), and initial ratio of partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) (±10). Outcome variables namely oxygenation indices (OI), ventilation index (VI), mechanical ventilation time and PICU time were compared.Results: Forty-four patients, 22 who received surfactant (surfactant group) and 22 who did not (control group) were analyzed. Surfactant group obtained a significant improvement on OI (13.9 vs 5.62; p=0.000) and VI (42.0 vs 22.4; p=0.000) in 6 hours, while control group got no improvement on OI (13.2 vs 11.5; p=0.065) and VI (40.2 vs 36.4; p=0.100). Compared with control group, surfactant group had shorter ventilation time (133.6h vs 218.4h; p=0.000) and PICU time (10.7d vs 17.5d; p=0.001). Infants in surfactant group under 3 months benefit more from OI and VI than infants over 3 months.Conclusions: In congenital heart disease infants with post-surgery ARDS, low-dose exogenous surfactant treatment could prominently improve oxygenation and reduced mechanical ventilation time and PICU time. And the improvement of oxygenation is more effective for infants under 3 months.

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Rosuvastatin Lowers Systemic Inflammatory Response in Coronary Artery Bypass Graft Accompanied by Cardiopulmonary Bypass Surgery: A Randomized Controlled Study

Cited by 14 publications

References 41 publications

Extracorporeal life support and systemic inflammation

Extracorporeal life support and systemic inflammation

Effect of low-dose exogenous surfactant on infants with acute respiratory distress syndrome after cardiac surgery: A retrospective analysis

Effect of low-dose exogenous surfactant on infants with acute respiratory distress syndrome after cardiac surgery: A retrospective analysis

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