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Published in: Inflammation 1/2014

Open Access 01-02-2014

Leukocyte Depletion During CPB: Effects on Inflammation and Lung Function

Authors: Célio Gomes de Amorim, Luiz Marcelo Sá Malbouisson, Francisco Costa da Silva Jr, Alfredo Inácio Fiorelli, Caroline Kameio Fernandes Murakami, Maria José Carvalho Carmona

Published in: Inflammation | Issue 1/2014

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Abstract

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.
Literature
1.
go back to reference Kollef, M.H., T. Wragge, and C. Pasque. 1995. Determinants of mortality and multiorgan dysfunction in cardiac surgery patients requiring prolonged mechanical ventilation. Chest 107: 1395–1401.CrossRef Kollef, M.H., T. Wragge, and C. Pasque. 1995. Determinants of mortality and multiorgan dysfunction in cardiac surgery patients requiring prolonged mechanical ventilation. Chest 107: 1395–1401.CrossRef
2.
go back to reference Ranieri, V.M., P.M. Suter, C. Tortorella, et al. 1999. Effect of mechanical ventilation on inflammatory mediators in patients with acute respiratory distress syndrome: a randomized controlled trial. Jama 282: 54–61.CrossRef Ranieri, V.M., P.M. Suter, C. Tortorella, et al. 1999. Effect of mechanical ventilation on inflammatory mediators in patients with acute respiratory distress syndrome: a randomized controlled trial. Jama 282: 54–61.CrossRef
3.
go back to reference Cremer, J., M. Martin, H. Redl, et al. 1996. Systemic inflammatory response syndrome after cardiac operations. Annals of Thoracic Surgery 61: 1714–1720.CrossRef Cremer, J., M. Martin, H. Redl, et al. 1996. Systemic inflammatory response syndrome after cardiac operations. Annals of Thoracic Surgery 61: 1714–1720.CrossRef
4.
go back to reference Laffey, J.G., J.F. Boylan, and D.C. Cheng. 2002. The systemic inflammatory response to cardiac surgery: implications for the anesthesiologist. Anesthesiology 97: 215–252.CrossRef Laffey, J.G., J.F. Boylan, and D.C. Cheng. 2002. The systemic inflammatory response to cardiac surgery: implications for the anesthesiologist. Anesthesiology 97: 215–252.CrossRef
5.
go back to reference Donnelly, S.C., R.M. Strieter, S.L. Kunkel, et al. 1993. Interleukin-8 and development of adult respiratory distress syndrome in at-risk patient groups. Lancet 341: 643–647.CrossRef Donnelly, S.C., R.M. Strieter, S.L. Kunkel, et al. 1993. Interleukin-8 and development of adult respiratory distress syndrome in at-risk patient groups. Lancet 341: 643–647.CrossRef
6.
go back to reference Apostolakis, E.E., E.N. Koletsis, N.G. Baikoussis, et al. 2010. Strategies to prevent intraoperative lung injury during cardiopulmonary bypass. Journal of Cardiothoracic Surgery 5: 1.CrossRef Apostolakis, E.E., E.N. Koletsis, N.G. Baikoussis, et al. 2010. Strategies to prevent intraoperative lung injury during cardiopulmonary bypass. Journal of Cardiothoracic Surgery 5: 1.CrossRef
7.
go back to reference Mihaljevic, T., M. Tonz, L.K. von Segesser, et al. 1995. The influence of leukocyte filtration during cardiopulmonary bypass on postoperative lung function. A clinical study. Journal of Thoracic and Cardiovascular Surgery 109: 1138–1145.CrossRef Mihaljevic, T., M. Tonz, L.K. von Segesser, et al. 1995. The influence of leukocyte filtration during cardiopulmonary bypass on postoperative lung function. A clinical study. Journal of Thoracic and Cardiovascular Surgery 109: 1138–1145.CrossRef
8.
go back to reference Hachida, M., N. Hanayama, T. Okamura, et al. 1995. The role of leukocyte depletion in reducing injury to myocardium and lung during cardiopulmonary bypass. Asaio Journal 41: M291–M294.CrossRef Hachida, M., N. Hanayama, T. Okamura, et al. 1995. The role of leukocyte depletion in reducing injury to myocardium and lung during cardiopulmonary bypass. Asaio Journal 41: M291–M294.CrossRef
9.
go back to reference Tao, K., Q. An, K. Lin, et al. 2009. Which is better to preserve pulmonary function: short-term or prolonged leukocyte depletion during cardiopulmonary bypass? Journal of Thoracic and Cardiovascular Surgery 138: 1385–1391.CrossRef Tao, K., Q. An, K. Lin, et al. 2009. Which is better to preserve pulmonary function: short-term or prolonged leukocyte depletion during cardiopulmonary bypass? Journal of Thoracic and Cardiovascular Surgery 138: 1385–1391.CrossRef
10.
go back to reference Asimakopoulos, G. 2002. The inflammatory response to CPB: the role of leukocyte filtration. Perfusion 17(Suppl): 7–10.CrossRef Asimakopoulos, G. 2002. The inflammatory response to CPB: the role of leukocyte filtration. Perfusion 17(Suppl): 7–10.CrossRef
11.
go back to reference Sheppard, S.V., R.V. Gibbs, and D.C. Smith. 2004. Does the use of leucocyte depletion during cardiopulmonary bypass affect exhaled nitric oxide production? Perfusion 19: 7–10.CrossRef Sheppard, S.V., R.V. Gibbs, and D.C. Smith. 2004. Does the use of leucocyte depletion during cardiopulmonary bypass affect exhaled nitric oxide production? Perfusion 19: 7–10.CrossRef
12.
go back to reference McBride, W.T., and S.J. McBride. 1998. The balance of pro- and anti-inflammatory cytokines in cardiac surgery. Current Opinion in Anaesthesiology 11: 15–22.CrossRef McBride, W.T., and S.J. McBride. 1998. The balance of pro- and anti-inflammatory cytokines in cardiac surgery. Current Opinion in Anaesthesiology 11: 15–22.CrossRef
13.
go back to reference Giannoudis, P.V., F. Hildebrand, and H.C. Pape. 2004. Inflammatory serum markers in patients with multiple trauma. Can they predict outcome? Journal of Bone & Joint Surgery, British 86: 313–323.CrossRef Giannoudis, P.V., F. Hildebrand, and H.C. Pape. 2004. Inflammatory serum markers in patients with multiple trauma. Can they predict outcome? Journal of Bone & Joint Surgery, British 86: 313–323.CrossRef
14.
go back to reference Galley, H.F., P.R. Lowe, R.L. Carmichael, et al. 2003. Genotype and interleukin-10 responses after cardiopulmonary bypass. British Journal of Anaesthesia 91: 424–426.CrossRef Galley, H.F., P.R. Lowe, R.L. Carmichael, et al. 2003. Genotype and interleukin-10 responses after cardiopulmonary bypass. British Journal of Anaesthesia 91: 424–426.CrossRef
15.
go back to reference Neidhardt, R., M. Keel, U. Steckholzer, et al. 1997. Relationship of interleukin-10 plasma levels to severity of injury and clinical outcome in injured patients. Journal of Trauma 42: 863–870. discussion 870–1.CrossRef Neidhardt, R., M. Keel, U. Steckholzer, et al. 1997. Relationship of interleukin-10 plasma levels to severity of injury and clinical outcome in injured patients. Journal of Trauma 42: 863–870. discussion 870–1.CrossRef
16.
go back to reference ASA. 1963. New classification of physical status. Anesthesiology 24: 111. ASA. 1963. New classification of physical status. Anesthesiology 24: 111.
17.
go back to reference Bernstein, A.D., and V. Parsonnet. 2000. Bedside estimation of risk as an aid for decision-making in cardiac surgery. Annals of Thoracic Surgery 69: 823–828.CrossRef Bernstein, A.D., and V. Parsonnet. 2000. Bedside estimation of risk as an aid for decision-making in cardiac surgery. Annals of Thoracic Surgery 69: 823–828.CrossRef
18.
go back to reference The Criteria Committee of the New York Heart Association. 1994. Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels. 9th ed. Boston (Mass): Little, Brown & Co; p. 253–256. The Criteria Committee of the New York Heart Association. 1994. Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels. 9th ed. Boston (Mass): Little, Brown & Co; p. 253–256.
19.
go back to reference Faymonville, M.E., J. Pincemail, J. Duchateau, et al. 1991. Myeloperoxidase and elastase as markers of leukocyte activation during cardiopulmonary bypass in humans. Journal of Thoracic and Cardiovascular Surgery 102: 309–317.CrossRef Faymonville, M.E., J. Pincemail, J. Duchateau, et al. 1991. Myeloperoxidase and elastase as markers of leukocyte activation during cardiopulmonary bypass in humans. Journal of Thoracic and Cardiovascular Surgery 102: 309–317.CrossRef
20.
go back to reference Gu, Y.J., A.J. de Vries, P.W. Boonstra, et al. 1996. Leukocyte depletion results in improved lung function and reduced inflammatory response after cardiac surgery. Journal of Thoracic and Cardiovascular Surgery 112: 494–500.CrossRef Gu, Y.J., A.J. de Vries, P.W. Boonstra, et al. 1996. Leukocyte depletion results in improved lung function and reduced inflammatory response after cardiac surgery. Journal of Thoracic and Cardiovascular Surgery 112: 494–500.CrossRef
21.
go back to reference Alexiou, C., S. Sheppard, A. Tang, et al. 2006. Leukocytes-depleting filters preferentially remove activated leukocytes and reduce the expression of surface adhesion molecules during the simulated extracorporeal circulation of human blood. Asaio Journal 52: 438–444.CrossRef Alexiou, C., S. Sheppard, A. Tang, et al. 2006. Leukocytes-depleting filters preferentially remove activated leukocytes and reduce the expression of surface adhesion molecules during the simulated extracorporeal circulation of human blood. Asaio Journal 52: 438–444.CrossRef
22.
go back to reference Alexiou, C., A.A. Tang, S.V. Sheppard, et al. 2004. The effect of leucodepletion on leucocyte activation, pulmonary inflammation and respiratory index in surgery for coronary revascularisation: a prospective randomised study. European Journal of Cardio-Thoracic Surgery 26: 294–300.CrossRef Alexiou, C., A.A. Tang, S.V. Sheppard, et al. 2004. The effect of leucodepletion on leucocyte activation, pulmonary inflammation and respiratory index in surgery for coronary revascularisation: a prospective randomised study. European Journal of Cardio-Thoracic Surgery 26: 294–300.CrossRef
23.
go back to reference Lust, R.M., A.P. Bode, L. Yang, et al. 1996. In-line leukocyte filtration during bypass. Clinical results from a randomized prospective trial. Asaio Journal 42: M819–M822.CrossRef Lust, R.M., A.P. Bode, L. Yang, et al. 1996. In-line leukocyte filtration during bypass. Clinical results from a randomized prospective trial. Asaio Journal 42: M819–M822.CrossRef
24.
go back to reference Ortolano, G.A., G.S. Aldea, K. Lilly, et al. 2002. A review of leukofiltration in cardiac surgery: the time course of reperfusion injury may facilitate study design of anti-inflammatory effects. Perfusion 17(Suppl): 53–62.CrossRef Ortolano, G.A., G.S. Aldea, K. Lilly, et al. 2002. A review of leukofiltration in cardiac surgery: the time course of reperfusion injury may facilitate study design of anti-inflammatory effects. Perfusion 17(Suppl): 53–62.CrossRef
25.
go back to reference Patel, A.N., S.W. Sutton, S. Livingston, A. Patel, et al. 2003. Clinical benefits of leukocyte filtration during valve surgery. American Journal of Surgery 186: 636–639. discussion 639–40.CrossRef Patel, A.N., S.W. Sutton, S. Livingston, A. Patel, et al. 2003. Clinical benefits of leukocyte filtration during valve surgery. American Journal of Surgery 186: 636–639. discussion 639–40.CrossRef
26.
go back to reference Bando, K., R. Pillai, D.E. Cameron, et al. 1990. Leukocyte depletion ameliorates free radical-mediated lung injury after cardiopulmonary bypass. Journal of Thoracic and Cardiovascular Surgery 99: 873–877.CrossRef Bando, K., R. Pillai, D.E. Cameron, et al. 1990. Leukocyte depletion ameliorates free radical-mediated lung injury after cardiopulmonary bypass. Journal of Thoracic and Cardiovascular Surgery 99: 873–877.CrossRef
27.
go back to reference Karaiskos, T.E., G.M. Palatianos, C.D. Triantafillou, et al. 2004. Clinical effectiveness of leukocyte filtration during cardiopulmonary bypass in patients with chronic obstructive pulmonary disease. Annals of Thoracic Surgery 78: 1339–1344.CrossRef Karaiskos, T.E., G.M. Palatianos, C.D. Triantafillou, et al. 2004. Clinical effectiveness of leukocyte filtration during cardiopulmonary bypass in patients with chronic obstructive pulmonary disease. Annals of Thoracic Surgery 78: 1339–1344.CrossRef
28.
go back to reference Matheis, G., M. Scholz, A. Simon, et al. 2001. Timing of leukocyte filtration during cardiopulmonary bypass. Perfusion 16(Suppl): 31–37.CrossRef Matheis, G., M. Scholz, A. Simon, et al. 2001. Timing of leukocyte filtration during cardiopulmonary bypass. Perfusion 16(Suppl): 31–37.CrossRef
29.
go back to reference Warren, O., C. Alexiou, R. Massey, et al. 2007. The effects of various leukocyte filtration strategies in cardiac surgery. European Journal of Cardio-Thoracic Surgery 31: 665–676.CrossRef Warren, O., C. Alexiou, R. Massey, et al. 2007. The effects of various leukocyte filtration strategies in cardiac surgery. European Journal of Cardio-Thoracic Surgery 31: 665–676.CrossRef
30.
go back to reference Whitaker, D.C., J.A. Stygall, S.P. Newman, et al. 2001. The use of leucocyte-depleting and conventional arterial line filters in cardiac surgery: a systematic review of clinical studies. Perfusion 16: 433–446.CrossRef Whitaker, D.C., J.A. Stygall, S.P. Newman, et al. 2001. The use of leucocyte-depleting and conventional arterial line filters in cardiac surgery: a systematic review of clinical studies. Perfusion 16: 433–446.CrossRef
31.
go back to reference Tenling, A., T. Hachenberg, H. Tyden, et al. 1998. Atelectasis and gas exchange after cardiac surgery. Anesthesiology 89: 371–378.CrossRef Tenling, A., T. Hachenberg, H. Tyden, et al. 1998. Atelectasis and gas exchange after cardiac surgery. Anesthesiology 89: 371–378.CrossRef
32.
go back to reference Olivencia-Yurvati, A.H., C.A. Ferrara, N. Tierney, N. Wallace, and R.T. Mallet. 2003. Strategic leukocyte depletion reduces pulmonary microvascular pressure and improves pulmonary status post-cardiopulmonary bypass. Perfusion 18(Suppl 1): 23–31.CrossRef Olivencia-Yurvati, A.H., C.A. Ferrara, N. Tierney, N. Wallace, and R.T. Mallet. 2003. Strategic leukocyte depletion reduces pulmonary microvascular pressure and improves pulmonary status post-cardiopulmonary bypass. Perfusion 18(Suppl 1): 23–31.CrossRef
33.
go back to reference Rodrigues, R.R., A.Y. Sawada, J.J. Rouby, et al. 2011. Computed tomography assessment of lung structure in patients undergoing cardiac surgery with cardiopulmonary bypass. Brazilian Journal of Medical and Biological Research 44: 598–605.CrossRef Rodrigues, R.R., A.Y. Sawada, J.J. Rouby, et al. 2011. Computed tomography assessment of lung structure in patients undergoing cardiac surgery with cardiopulmonary bypass. Brazilian Journal of Medical and Biological Research 44: 598–605.CrossRef
34.
go back to reference Theobaldo, M.C., H.V. Barbeiro, D.F. Barbeiro, et al. 2012. Hypertonic saline solution reduces the inflammatory response in endotoxemic rats. Clinics 67: 1463–1468.CrossRef Theobaldo, M.C., H.V. Barbeiro, D.F. Barbeiro, et al. 2012. Hypertonic saline solution reduces the inflammatory response in endotoxemic rats. Clinics 67: 1463–1468.CrossRef
35.
go back to reference Nishii, M., T. Inomata, H. Takehana, et al. 2004. Serum levels of interleukin-10 on admission as a prognostic predictor of human fulminant myocarditis. Journal of the American College of Cardiology 44: 1292–1297.CrossRef Nishii, M., T. Inomata, H. Takehana, et al. 2004. Serum levels of interleukin-10 on admission as a prognostic predictor of human fulminant myocarditis. Journal of the American College of Cardiology 44: 1292–1297.CrossRef
36.
go back to reference Giomarelli, P., S. Scolletta, E. Borrelli, et al. 2003. Biagioli B. Myocardial and lung injury after cardiopulmonary bypass: role of interleukin (IL)-10. Annals of Thoracic Surgery 76: 117–123.CrossRef Giomarelli, P., S. Scolletta, E. Borrelli, et al. 2003. Biagioli B. Myocardial and lung injury after cardiopulmonary bypass: role of interleukin (IL)-10. Annals of Thoracic Surgery 76: 117–123.CrossRef
Metadata
Title
Leukocyte Depletion During CPB: Effects on Inflammation and Lung Function
Authors
Célio Gomes de Amorim
Luiz Marcelo Sá Malbouisson
Francisco Costa da Silva Jr
Alfredo Inácio Fiorelli
Caroline Kameio Fernandes Murakami
Maria José Carvalho Carmona
Publication date
01-02-2014
Publisher
Springer US
Published in
Inflammation / Issue 1/2014
Print ISSN: 0360-3997
Electronic ISSN: 1573-2576
DOI
https://doi.org/10.1007/s10753-013-9730-z

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