Role of endogenous adenosine as a predictive marker of vasoplegia during cardiopulmonary bypass and postoperative severe systemic inflammatory response

Heparin-coated circuits have been subjected to vigorous testing, both experimentally and clinically, for the past decade. When the functions of heparin are preserved on the surface, the heparinized surface plays multiple roles in attenuating the systemic inflammatory response. These include the ability to attenuate contact activation, coagulation activation, complement activation and, directly or indirectly, platelet and leukocyte activation. The heparinized surface also renders the cardiopulmonary bypass (CPB) circuits hydrophilic and protein resistant and augments lipoprotein binding. The multifunctional nature of the heparinized surface contributes to the overall biocompatibility of the surface. Clinically, heparin-coated circuits become most effective in reducing systemic inflammatory response and in improving morbidity, mortality, and other patient outcome related parameters when material-independent blood activation is controlled or minimized through a global biocompatibility strategy. Techniques involved in the global biocompatibility strategy are readily available and are being effectively and safely practiced at several centers. With the global biocompatibility strategy, outstanding and reproducible results have been routinely achieved with conventional CPB techniques. Alternative revascularization procedures should equal or surpass conventional CPB, using best clinically proven strategies with respect to patient outcome and long-term graft patency.

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The Role of the Systemic Inflammatory Response in Predicting Outcome in Patients with Pancreatic Cancer

Pancreatic Disease ◽

10.1007/978-1-84882-118-7_11 ◽

2009 ◽

pp. 97-102

Author(s):

Donald C. McMillan

Keyword(s):

Pancreatic Cancer ◽

Inflammatory Response ◽

Systemic Inflammatory Response ◽

Predicting Outcome

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PREVENTION OF SYSTEMIC INFLAMMATORY RESPONSE DURING LONG-STANDING CARDIOPULMONARY BYPASS IN PATIENTS WITH COMORBIDITIES

Clinical Anesthesiology and intensive Care ◽

10.31379/2411.2616.14.2.3 ◽

2019 ◽

Vol 2 (14) ◽

pp. 25-34

Author(s):

Vladimir Chagirev ◽

Mikhail Rubtsov ◽

Giorgiy Edzhibiya ◽

Valeriya Komkova ◽

Georgiy Plotnikov ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Inflammatory Response ◽

Systemic Inflammatory Response

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Treatment of systemic inflammatory response syndrome following on-pump pediatric congenital heart surgery

Complex Issues of Cardiovascular Diseases ◽

10.17802/2306-1278-2021-10-2-113-124 ◽

2021 ◽

Vol 10 (2) ◽

pp. 113-124

Author(s):

D. V. Borisenko ◽

A. A. Ivkin ◽

D. L. Shukevich

Keyword(s):

Cardiopulmonary Bypass ◽

Systemic Inflammatory Response Syndrome ◽

Inflammatory Response ◽

Congenital Heart ◽

Heart Surgery ◽

Heart Defects ◽

Surgical Techniques ◽

Congenital Heart Surgery ◽

Systemic Inflammatory Response ◽

Preventive Strategies

Highlights. The article discusses the pathophysiological aspects of cardiopulmonary bypass and the mechanisms underlying the development of the systemic inflammatory response in children following congenital heart surgery. We summarize and report the most relevant preventive strategies aimed at reducing the systemic inflammatory response, including both, CPB-related methods and pharmacological ones.The growing number of children with congenital heart defects requires the development of more advanced technologies for their surgical treatment. However, cardiopulmonary bypass is required in almost all surgical techniques. Despite the tremendous progress and recent advances in cardiopulmonary bypass techniques, the systemic inflammatory response syndrome associated with these surgeries remains unresolved. The review summarizes the causes and mechanisms underlying its development. The most commonly used preventive strategies are reported, including standard and modified ultrafiltration, leukocyte filters, and pharmacological agents (systemic glucocorticoids, aprotinin, and antioxidants).The role of cardioplegia and hypothermia in the reduction of systemic inflammation is defined. Cardiac surgery centers around the world use a variety of techniques and pharmacological approaches, drawing on the results of randomized clinical studies. However, there are no clear and definite clinical guidelines aimed at reducing the systemic inflammatory response during cardiopulmonary bypass in children. It remains a significant problem for pediatric intensive care by aggravating their postoperative status, prolonging the length of the in-hospital stay, and reducing the survival rates.

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