The systemic inflammatory response syndrome following cardiac surgery: different expression of proinflammatory cytokines and procalcitonin in patients with and without multiorgan dysfunctions

Perfusion ◽  
2002 ◽  
Vol 17 (2) ◽  
pp. 103-109 ◽  
Author(s):  
Armin Sablotzki ◽  
Ivar Friedrich ◽  
Jörg Mühling ◽  
Marius G Dehne ◽  
Jan Spillner ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Multiple Organ ◽  
Systemic Inflammatory Response ◽  
Apache Ii Score ◽  
Organ Dysfunctions

Cardiopulmonary bypass is associated with an injury that may cause pathophysiological changes in the form of systemic inflammatory response syndrome (SIRS) or multiple organ dysfunction syndrome (MODS). In the present study, we investigated the inflammatory response of patients with multiple organ dysfunctions following open-heart surgery. Plasma levels of cytokines (IL-1β, IL-6, IL-8, IL-18) and procalcitonin (PCT) were measured on the first four postoperative days in 12 adult male patients with SIRS and two or more organ dysfunctions after myocar-dial revascularization (MODS group), and 15 patients without organ dysfunctions (SIRS group). All cytokines (except IL-1β) and PCT were significantly elevated in MODS patients, with peak values at the first two postoperative days. The results of our study show a different expression of members of the IL-1 family following extracorporeal circulation. For the first time, we can document that IL-18 is involved in the inflammatory response and the initiation of the MODS following cardiopulmonary bypass. In addition to APACHE-II score, PCT, IL-8, and IL-18 may be used as parameters for the prognosis of patients with organ dysfunctions after cardiac surgery. Furthermore, it must be noted that the duration of the surgical procedure is one of the most important factors for the initiation of the inflammatory response.

Role of modified ultrafiltration in reduce of the systemic inflammatory response syndrome in cardiac surgery

2016 ◽  
Vol 7 (1) ◽  
pp. 106-110 ◽  
Author(s):  
Gennadiy G Khubulava ◽  
Sergey P Marchenko ◽  
Ekaterina V Dubova ◽  
Vitaliy V Suvorov
Keyword(s):  
Cardiac Surgery ◽  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Inflammatory Mediators ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Systemic Circulation ◽  
Systemic Inflammatory Response ◽  
Mechanical Removal ◽  
The Moment

During open-heart surgery it is possible to disturbance of the barrier function and the appearance of inflammation in the systemic circulation of inflammatory mediators and pro-inflammatory cytokines, which is realized in the systemic inflammatory response syndrome (SIRS). To prevent the development of the condition, or to reduce the severity of its complications method of mechanical removal of inflammatory mediators and cytokines from the blood of the patient is the most efficient. At the moment, the problem of implementation of the systemic inflammatory response syndrome after surgery using cardiopulmonary bypass quite relevant because of the high frequency of its manifestations and adverse effects [18]. This explains the large number of studies aimed at both the study of the pathogenesis of systemic inflammatory response syndrome and the development of new methods to combat this phenomenon and the improvement of already applied methods and techniques [1, 4]. There are various ways to the reduction of the degree of systemic inflammatory response syndrome, but special attention is given to the study of methods of modified ultrafiltration and continuous veno-venous hemofiltration. Further study of the application of ultrafiltration on patients undergoing cardiac surgery heart surgery with the use of bypass is necessary for understanding of the physiology and pathophysiology of systemic inflammatory response syndrome induced by the conduct of bypass, as well as for the subsequent formulation of clinical guidelines for use in cardiac surgery practice. In this article we have tried to consider the most significant results of such studies.

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

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.

The value of procalcitonin in systemic inflammatory response syndrome after open-heart surgery for CHD

2019 ◽  
Vol 29 (11) ◽  
pp. 1335-1339
Author(s):  
Kuntum Basitha ◽  
Rubiana Sukardi ◽  
Ratna Farida Soenarto ◽  
Suprayitno Wardoyo
Keyword(s):  
Platelet Count ◽  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Systemic Inflammatory Response ◽  
Open Heart ◽  
Time Duration ◽  
Procalcitonin Level ◽  
Significant Difference

AbstractBakground:Systemic inflammatory response syndrome, which is marked by fever, is a possible complication after open-heart surgery for CHD. The inflammatory response following the use of cardiopulmonary bypass shows similar clinical signs with sepsis. Therefore serial measurements of procalcitonin, an early infection marker, can be helpful to differentiate between sepsis and systemic inflammatory response syndrome.Objectives:To evaluate serial levels of procalcitonin in children who underwent open-heart surgery for cyanotic and acyanotic CHD, and identify factors associated with elevated level of procalcitonin.Methods:Children and infants who had open-heart surgery and showed fever within 6 hours after surgery were recruited. Procalcitonin levels were serially measured along with leukocyte and platelet count. Other data were also recorded, including diagnosis, age, body weight, axillary temperature, aortic clamp time, bypass time, duration of mechanical ventilation, risk adjustment for congenital heart surgery score-1, and length of stay in Cardiac ICU. The patients were categorised into cyanotic and acyanotic CHD groups.Results:High mean of procalcitonin level suggested the presence of bacterial infection. Cyanotic CHD group had significantly higher mean of procalcitonin level compared to acyanotic CHD group in the first two measurements. Both groups had no leukocytosis, though platelet count results were significantly different between the two groups. There was no significant difference of procalcitonin level observed in culture results and adverse outcomes.Conclusion:Serial procalcitonin measurement can be helpful to determine the cause of fever. Meanwhile other conventional markers such as leukocyte and platelet should be assessed thoroughly.

scholarly journals Analysis of Dynamic Changes in Cognitive Workload During Cardiac Surgery Perfusionists′ Interactions With the Cardiopulmonary Bypass Pump

2020 ◽  
pp. 001872082097629
Author(s):  
Lauren R. Kennedy-Metz ◽  
Roger D. Dias ◽  
Rithy Srey ◽  
Geoffrey C. Rance ◽  
Heather M. Conboy ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Heart Surgery ◽  
Time Windows ◽  
Open Heart Surgery ◽  
Real Life ◽  
Skin Incision ◽  
Cognitive Workload ◽  
Dynamic Changes ◽  
Pump Operation

Objective This novel preliminary study sought to capture dynamic changes in heart rate variability (HRV) as a proxy for cognitive workload among perfusionists while operating the cardiopulmonary bypass (CPB) pump during real-life cardiac surgery. Background Estimations of operators’ cognitive workload states in naturalistic settings have been derived using noninvasive psychophysiological measures. Effective CPB pump operation by perfusionists is critical in maintaining the patient’s homeostasis during open-heart surgery. Investigation into dynamic cognitive workload fluctuations, and their relationship with performance, is lacking in the literature. Method HRV and self-reported cognitive workload were collected from three Board-certified cardiac perfusionists ( N = 23 cases). Five HRV components were analyzed in consecutive nonoverlapping 1-min windows from skin incision through sternal closure. Cases were annotated according to predetermined phases: prebypass, three phases during bypass, and postbypass. Values from all 1min time windows within each phase were averaged. Results Cognitive workload was at its highest during the time between initiating bypass and clamping the aorta (preclamp phase during bypass), and decreased over the course of the bypass period. Conclusion We identified dynamic, temporal fluctuations in HRV among perfusionists during cardiac surgery corresponding to subjective reports of cognitive workload. Not only does cognitive workload differ for perfusionists during bypass compared with pre- and postbypass phases, but differences in HRV were also detected within the three bypass phases. Application These preliminary findings suggest the preclamp phase of CPB pump interaction corresponds to higher cognitive workload, which may point to an area warranting further exploration using passive measurement.

Possible role of increased oxidant stress in multiple organ failure after systemic inflammatory response syndrome

2003 ◽  
Vol 31 (4) ◽  
pp. 1048-1052 ◽  
Author(s):  
Takeshi Motoyama ◽  
Kazufumi Okamoto ◽  
Ichirou Kukita ◽  
Masamichi Hamaguchi ◽  
Yoshihiro Kinoshita ◽  
...  
Keyword(s):  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Multiple Organ Failure ◽  
Organ Failure ◽  
Oxidant Stress ◽  
Multiple Organ ◽  
Systemic Inflammatory Response
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