Artículos de revistas
The Use Of Ultrafiltration For Inflammatory Mediators Removal During Cardiopulmonary Bypass In Coronary Artery Bypass Graf Surgery
Registro en:
Brazilian Journal Of Cardiovascular Surgery. , v. 23, n. 2, p. 175 - 182, 2008.
1027638
2-s2.0-53049107459
Autor
Antunes N.
Dragosavc D.
Petrucci Jr. O.
De Oliveira P.P.M.
Kosour C.
Blotta M.H.S.L.
Braile D.M.
Vieira R.W.
Institución
Resumen
Objective: To investigate the effectiveness of ultrafiltration in removing inflammatory mediators released by cardiopulmonary bypass and to correlate ultrafiltration with alterations in organic function according to the Sequential Organ Failure Assessment Score. Methods: Forty patients were included and randomized into two groups: "no ultrafiltration" (n=20; Group I) and "ultrafiltration" (n=20; Group II). Activated complement 3 and 4, interleukins 1beta, 6, 8 and tumor necrosis factor alfa were measured prior to anesthesia induction (Time 1), 5 minutes before cardiopulmonary bypass (Time 2), in the ultrafiltrated fluid (Time 3), 30 minutes (Time 4), and 6 (Time 5), 12 (Time 6), 24 (Time 7), 36 (Time 8) and 48 (Time 9) hours following cardiopulmonary bypass. Sequential Organ Failure Assessment Score was evaluated at Time 1, 6 and 9. Statistical significance was established at p ≤ 0.05. Results: In the ultrafiltrated fluid, only tumor necrosis factor alfa levels were detected. Levels of activated complement 3 at Times 5 and 7 and activated complement 4 at Times 5 and 6 were significantly higher in the unfiltered Group, and levels of interleukin 6 were higher in the filtered Group at Times 7 and 8. Interleukins 1beta, 8, tumor necrosis factor alfa, and the Sequential Organ Failure Assessment score were not significantly different between the groups. Conclusions: Ultrafiltration significantly filtered tumor necrosis factor alfa but did not influences serum levels of this cytokine. Ultrafiltration with the type of filter used in this study had no effect in organic dysfunction and should be used only for volemic control in patients undergo cardiopulmonary bypass. 23 2 175 182 Westaby, S., Organ dysfunction after cardiopulmonary bypass: A systemic inflammatory reaction initiated by the extracorporeal circuit (1987) Intensive Care Med, 13 (2), pp. 89-95 Edmunds Jr., L.H., Inflammatory response to cardiopulmonary bypass (1998) Ann Thorac Surg, 66 (5 SUPPL.), pp. S12-S16 Royston, D., The inflammatory response and extracorporeal circulation (1997) J Cardiothorac Vasc Anesth, 11 (3), pp. 341-354 Moat, N.E., Shore, D.F., Evans, T.W., Organ dysfunction and cardiopulmonary bypass: The role of complement and complement regulatory proteins (1993) Eur J Cardiothorac Surg, 7 (11), pp. 563-573 Frering, B., Philip, I., Dehoux, M., Rolland, C., Langlois, J.M., Desmonts, J.M., Circulating cytokines in patients undergoing normothermic cardiopulmonary bypass (1994) J Thorac Cardiovasc Surg, 108 (4), pp. 636-641 Nashef, S.A., Roques, F., Hammill, B.G., Peterson, E.D., Michel, P., Grover, F.L., Validation of European System for Cardiac Operative Risk Evaluation (EuroSCORE) in North American cardiac surgery (2002) Eur J Cardiothorac Surg, 22 (1), pp. 101-105 Vincent, J.L., Mendonça, A., Cantraine, F., Moreno, R., Takala, J., Suter, P.M., Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: Results of a multicenter, prospective study. Working group on "sepsis-related problems" of the European Society of Intensive Care Medicine (1998) Crit Care Med, 26 (11), pp. 1793-1800 Ungerleider, R.M., Effects of cardiopulmonary bypass and use of modified ultrafiltration (1998) Ann Thorac Surg, 65 (6 SUPPL.), pp. S35-S38 Tetta, C., D'Intini, V., Bellomo, R., Bonello, M., Bordoni, V., Ricci, Z., Extracorporeal treatments in sepsis: Are there new perspectives? (2003) Clin Nephrol, 60 (5), pp. 299-304 Biglioli, P., Cannata, A., Alamanni, F., Naliato, M., Porqueddu, M., Zanobini, M., Biological effects of off-pump vs. on-pump coronary artery surgery: Focus on inflammation, hemostasis and oxidative stress (2003) Eur J Cardiothorac Surg, 24 (2), pp. 260-269 Wang, M.J., Chiu, I.S., Hsu, C.M., Wang, C.M., Lin, P.L., Chang, C.I., Efficacy of ultrafiltration in removing inflammatory mediators in pediatric cardiac operations (1996) Ann Thorac Surg, 61 (2), pp. 651-656 Wan, S., Yim, A.P., Arifi, A.A., Lee, T.W., Huynh, C.H., DeSmet, J.M., Can cardioplegia management influence cytokine responses during clinical cardiopulmonary bypass? (1999) Ann Thorac Cardiovasc Surg, 5 (2), pp. 81-85 Brunet, S., Leblanc, M., Geadah, D., Parent, D., Courteau, S., Cardinal, J., Diffusive and convective solute clearances during continuous renal replacement therapy at various dialysate and ultrafiltration flow rates (1999) Am J Kidney Dis, 34 (3), pp. 486-492 Venkataraman, R., Subramanian, S., Kellum, J.A., Clinical review: Extracorporeal blood purification in severe sepsis (2003) Crit Care, 7 (2), pp. 139-145 Dinarello, C.A., Proinflammatory and anti-inflammatory cytokines as mediators in the pathogenesis of septic shock (1997) Chest, 112 (6 SUPPL.), pp. 321S-329S Janovich, H.B., (1991) The cytokine handbook, p. 5. , London:Academic Press; Butler, J., Rocker, G.M., Westaby, S., Inflammatory response to cardiopulmonary bypass (1993) Ann Thorac Surg, 55 (2), pp. 552-559 Butler, J., Chong, G.L., Baigrie, R.J., Pillai, R., Westaby, S., Rocker, G.M., Cytokine responses to cardiopulmonary bypass with membrane and bubble oxygenation (1992) Ann Thorac Surg, 53 (5), pp. 833-838 Ohzato, H., Yoshizaki, K., Nishimoto, N., Ogata, A., Tagoh, H., Monden, M., Interleukin-6 as a new indicator of inflammatory status: Detection of serum levels of interleukin-6 and C-reactive protein after surgery (1992) Surgery, 111 (2), pp. 201-209 Royston, D., Fleming, J.S., Desai, J.B., Westaby, S., Taylor, K.M., Increased production of peroxidation products associated with cardiac operations: Evidence for free radical generation (1986) J Thorac Cardiovasc Surg, 91 (5), pp. 759-766 Finn, A., Naik, S., Klein, N., Levinsky, R.J., Strobel, S., Elliott, M., Interleukin-8 release and neutrophil degranulation after pediatric cardiopulmonary bypass (1993) J Thorac Cardiovasc Surg, 105 (2), pp. 234-241 George, J.F., Invited letter concerning: Cytokines and mechanisms of capillary leakage after cardiopulmonary bypass (1993) J Thorac Cardiovasc Surg, 106 (3), pp. 566-567 Brasil, L.A., Gomes, W.J., Salomão, R., Buffolo, E., Inflammatory response after myocardial revascularization with or without cardiopulmonary bypass (1998) Ann Thorac Surg, 66 (1), pp. 56-59 Chenoweth, D.E., Cooper, S.W., Hugli, T.E., Stewart, R.W., Blackstone, E.H., Kirklin, J.W., Complement activation during cardiopulmonary bypass: Evidence for generation of C3a and C5a anaphylatoxins (1981) N Engl J Med, 304 (9), pp. 497-503 Hill, G.E., Alonso, A., Thiele, G.M., Robbins, R.A., Glucocorticoids blunt neutrophil CD11b surface glycoprotein upregulation during cardiopulmonary bypass in humans (1994) Anesth Analg, 79 (1), pp. 23-27 Inaba, H., Kochi, A., Yorozu, S., Suppression by methylprednisolone of augmented plasma endotoxin-like activity and interleukin-6 during cardiopulmonary bypass (1994) Br J Anaesth, 72 (3), pp. 348-350 Dietzman, R.H., Casteda, A.R., Lillehei, C.W., Ersera, Motsay, G.J., Lillehei, R.C., Corticosteroids as effective vasodilators in the treatment of low output syndrome (1970) Chest, 57 (5), pp. 440-453 Niazi, Z., Flodin, P., Joyce, L., Smith, J., Mauer, H., Lillehei, R.C., Effects of glucocorticosteroids in patients undergoing coronary artery bypass surgery (1979) Chest, 76 (3), pp. 262-268 Fey, K., Follette, D., Livesay, J., Nelson, R., Bugyi, H., DeLand, Effects of membrane stabilization on the safety of hypothermic arrest after aortic cross-clamping (1977) Circulation, 56 (3 SUPPL.), pp. II143-II147 Fosse, E., Mollnes, T.E., Ingvaldsen, B., Complement activation during major operations with or without cardiopulmonary bypass (1987) J Thorac Cardiovasc Surg, 93 (6), pp. 860-866 Brasil, L.A., Gomes, W.J., Salomão, R., Fonseca, J.H.P., Branco, J.N.R., Buffolo, E., Uso de corticóide como inibidor da resposta inflamatória sistêmica induzida pela circulação extracorpórea. (1999) Rev Bras Cir Cardiovasc, 14 (3), pp. 254-268 Jansen, N.J., van Oeveren, W., van den Broek, L., Oudemans-van Straaten, H.M., Stoutenbeek, C.P., Joen, M.C., Inhibition by dexamethasone of the reperfusion phenomena in cardiopulmonary bypass (1991) J Thorac Cardiovasc Surg, 102 (4), pp. 515-525 Liakopoulos, O.J., Teucher, N., Mühlfeld, C., Middel, P., Heusch, G., Schoendube, F.A., Prevention of TNFalpha-associated myocardial dysfunction resulting from cardiopulmonary bypass and cardioplegic arrest by glucocorticoid treatment (2006) Eur J Cardiothorac Surg, 30 (2), pp. 263-270 Liakopoulos, O.J., Schmitto, J.D., Kazmaier, S., Bräuer, A., Quintel, M., Schoendube, F.A., Cardiopulmonary and systemic effects of methylprednisolone in patients undergoing cardiac surgery (2007) Ann Thorac Surg, 84 (1), pp. 110-118 De Vriese, A.S., Colardyn, F.A., Philippé, J.J., Vanholder, R.C., De Sutter, J.H., Lameire, N.H., Cytokine removal during continuous hemofiltration in septic patients (1999) J Am Soc Nephrol, 10 (4), pp. 846-853,183-189