Systemic inflammatory response syndrome and surgical stress in thoracic surgery

Takenaka, Kazumasa; Ogawa, Eiji; Wada, Hiromi; Hirata, Toshiki

doi:10.1016/j.jcrc.2005.07.001

Cited by 59 publications

(48 citation statements)

References 21 publications

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“…An increase in TNF-α levels was found to increase pleural vascular permeability in a murine model, a key factor in the accumulation of fluid in the pleura (22). Takenaka et al found that patients undergoing thoracic surgery who developed symptoms of systemic inflammatory response syndrome (with associated elevation of IL-6 concentrations) were admitted 4 days longer with increased pleural drainage volumes (7). Minimally invasive surgical thoracic approaches were found to be associated with lower cytokine concentrations in comparison with open procedures, indicating that less trauma possibly triggers less inflammation, with improved patients outcomes (24)(25)(26).…”

Section: Discussionmentioning

confidence: 99%

“…Continuous suction of the pleural space without feedback increases the pressure gradient for fluid filtration across the pleural membrane and can potentiate a local inflammatory response. Recent research has demonstrated an association between increased pleural inflammation and pleural effusion (6,7). Conversely, the digital suction system maintains a pre-specified intrapleural negative pressure by applying intermittent negative suction, depending on real-time measurements of intrapleural pressures (8).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Does the usage of digital chest drainage systems reduce pleural inflammation and volume of pleural effusion following oncologic pulmonary resection?—A prospective randomized trial

Waele¹,

Agzarian²,

Hanna³

et al. 2017

J. Thorac. Dis.

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Background: Prolonged air leak and high-volume pleural drainage are the most common causes for delays in chest tube removal following lung resection. While digital pleural drainage systems have been successfully used in the management of post-operative air leak, their effect on pleural drainage and inflammation has not been studied before. We hypothesized that digital drainage systems (as compared to traditional analog continuous suction), using intermittent balanced suction, are associated with decreased pleural inflammation and postoperative drainage volumes, thus leading to earlier chest tube removal. Methods: One hundred and three [103] patients were enrolled and randomized to either analog (n=50) or digital (n=53) drainage systems following oncologic lung resection. Chest tubes were removed according to standardized, pre-defined protocol. Inflammatory mediators [interleukin-1B (IL-1B), 6, 8, tumour necrosis factor-alpha (TNF-α)] in pleural fluid and serum were measured and analysed. The primary outcome of interest was the difference in total volume of postoperative fluid drainage. Secondary outcome measures included duration of chest tube in-situ, prolonged air-leak incidence, length of hospital stay and the correlation between pleural effusion formation, degree of inflammation and type of drainage system used.Results: There was no significant difference in total amount of fluid drained or length of hospital stay between the two groups. A trend for shorter chest tube duration was found with the digital system when compared to the analog (P=0.055). Comparison of inflammatory mediator levels revealed no significant differences between digital and analog drainage systems. The incidence of prolonged post-operative air leak was significantly higher when using the analog system (9 versus 2 patients; P=0.025). Lobectomy was associated with longer chest tube duration (P=0.001) and increased fluid drainage when compared to sublobar resection (P<0.001), regardless of drainage system. Conclusions: Use of post-lung resection digital drainage does not appear to decrease pleural fluid formation, but is associated with decreased prolonged air leaks. Total pleural effusion volumes did not differ with the type of drainage system used. These findings support previously established benefits of the digital system in decreasing prolonged air leaks, but the advantages do not appear to extend to decreased pleural fluid formation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Does the usage of digital chest drainage systems reduce pleural inflammation and volume of pleural effusion following oncologic pulmonary resection?—A prospective randomized trial

Waele¹,

Agzarian²,

Hanna³

et al. 2017

J. Thorac. Dis.

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“…Excessive surgical stress results in a disruption of the homeostasis of the body and is known to cause various postoperative complications. Usually the surgical method, operation time, and intraoperative blood loss, etc., have been regarded as related surgical stresses and closely associated with the postoperative morbidity and mortality [11,12]. Other studies have reported that changes in the neuroendocrine or immune responses reflect the degree of surgical stress [13][14][15][16][17][18][19][20].…”

Section: Discussionmentioning

confidence: 99%

Total Thyroidectomy in the Mouse: the Feasibility Study in the Non-thyroidal Tumor Model Expressing Human Sodium/Iodide Symporter Gene

Shim

Kim

et al. 2011

Nucl Med Mol Imaging

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“…As a consequence, outpatient surgery centers proliferated; Crile's principles of early admission, premedication, late discharge, and analgesic supplementation were abandoned; and anesthesiologists ignored permissive hypercarbia, re-abandoned opioids, and re-embraced the classic Waters technique [122] . By 1997 the results of inadequate surgical stress control manifested as the previously unknown Systemic Inlammatory Response Syndrome ("SIRS"), but the compelling coincidence was ignored [46,[123][124][125] . The tragedy became complete in 2005, when Dr. Terri Monk published her landmark study that unexpectedly revealed a 30% increase in morbidity and mortality in the distant aftermath of surgery that is inluenced by anesthetic management [48] .…”

Section: Recent Historymentioning

confidence: 99%

Four Forgotten Giants of Anesthesia History

Coleman¹,

Internationals²

2016

JAS

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Introduction Does wisdom perhaps appear on the earth as a raven, which is inspired by the smell of carrion? --Friedrich NietzschePast is prologue. Carbon dioxide confusion has played a pivotal role in the evolution of modern anesthesia. Professional anesthesiology organizations have persistently neglected CO 2 management standards in favor of lesser issues [1][2][3][4] , so that the anesthesiology profession remains mired at the crossroads of revolutionary advance and ongoing self-destruction that can only be understood in historical context. Dr. Ralph Waters founded the profession on the basis of a practical new technique that introduced elective intubation and hyperventilation to abolish CO 2 toxicity disasters, but the harmful habit of hyperventilation has distorted anesthesia beliefs, habits, and practices; derailed research; halted professional advance; discouraged opioid treatment; abolished the therapeutic beneits of CO 2 ; exaggerated morbidity and mortality; and introduced a host of vexing clinical problems. It has indirectly fostered the iction that further improvements in anesthesia safety are impossible, which has undermined reimbursement, emasculated staf privileges, devastated morale, discouraged professional membership A , and rationalized the replacement of anesthesiologists by nurses.Meanwhile, the confusing chemistry, physiology, and pathology of carbon dioxide have yielded their secrets, modern anesthesia machines have eliminated the toxicity problem, modern agents have eliminated explosions, and modern monitoring AbstractThe anesthesiology profession may one day serve as a cautionary tale of how power, politics and privilege can perturb science and progress. Previous anesthesia practitioners possessed a superior understanding of physiology and pharmacology, but overenthusiastic CO 2 supplementation with inadequate monitors and machines caused asphyxiation disasters that were improperly attributed to CO 2 toxicity. Dr. Ralph Waters founded the anesthesiology profession on the basis of a practical new anesthetic technique that introduced elective intubation and hyperventilation to eliminate CO 2 toxicity, but mechanical hyperventilation dangerously depletes CO 2 tissue reserves and exaggerates morbidity and mortality. The beneits of CO 2 supplementation were forgotten, and consequent CO 2 confusion has derailed research, discouraged opioid treatment, damaged patient safety, and disrupted professional progress. Anesthesiologists can no longer claim to provide superior service, and hospital administrators are replacing them with nurses. Professional membership is in decline, and professional survival is in question. Modern machines have eliminated asphyxiation, and modern monitoring enables safe and beneicial hypercarbia that complements opioid treatment and minimizes surgical morbidity and mortality. CO 2 reform promises revolutionary advance but faces formidable opposition. [5] . The restoration of past principles using modern capnography, pulse oximetry, synthetic opioids, and improved inha...

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Systemic inflammatory response syndrome and surgical stress in thoracic surgery

Cited by 59 publications

References 21 publications

Does the usage of digital chest drainage systems reduce pleural inflammation and volume of pleural effusion following oncologic pulmonary resection?—A prospective randomized trial

Does the usage of digital chest drainage systems reduce pleural inflammation and volume of pleural effusion following oncologic pulmonary resection?—A prospective randomized trial

Total Thyroidectomy in the Mouse: the Feasibility Study in the Non-thyroidal Tumor Model Expressing Human Sodium/Iodide Symporter Gene

Four Forgotten Giants of Anesthesia History

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