scholarly journals Comparison of Microcirculatory Perfusion in Obese and Non-Obese Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass

2021 ◽  
Vol 10 (3) ◽  
pp. 469
Author(s):  
Chantal A. Boly ◽  
Margot Venhuizen ◽  
Nicole A. M. Dekker ◽  
Alexander B. A. Vonk ◽  
Christa Boer ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Type Ii Diabetes Mellitus ◽  
Dark Field ◽  
Multiple Organ ◽  
Obese Patients ◽  
Sidestream Dark Field ◽  
Microcirculatory Perfusion ◽  
Metabolically Healthy Obese ◽  
Healthy Obese

Obesity is a frequent comorbidity among patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Cardiac surgery with CPB impairs microcirculatory perfusion, which is associated with multiple organ failure. As microvascular function is frequently compromised in obese patients, we studied whether cardiac surgery with CPB has a more detrimental effect on microcirculatory perfusion in obese patients. Sublingual microcirculatory perfusion was measured with sidestream dark field (SDF) imaging in obese patients (body mass index ≥32 kg/m2; n = 14) without type II diabetes mellitus and in lean patients (BMI 20–25 kg/m2; n = 22) undergoing cardiac surgery with CPB. CPB reduced systolic blood pressure and mean arterial pressure more profoundly in lean compared with obese patients (SBP: 38% vs. 18%; MAP: 11% vs. 8%, p < 0.05), and both restored after weaning from CPB. No differences were present in intraoperative glucose, hematocrit, hemoglobin, lactate, and blood gas values between obese and lean patients. Microcirculatory perfusion did not differ between obese and lean patients the day before surgery. CPB decreased microcirculatory perfusion with 9% in both groups, but this was only significant in lean patients (p < 0.05). Three days following surgery, microcirculatory perfusion was restored in both groups. In conclusion, microcirculatory perfusion was equally disturbed during cardiac surgery with CPB in metabolically healthy obese patients compared to lean patients.

scholarly journals The prevalence of metabolically healthy obesity according to the sample of the Moscow region

2017 ◽  
Vol 14 (4) ◽  
pp. 51-56 ◽  
Author(s):  
Elena V. Ostrovskaya ◽  
Tatiana I. Romantsova ◽  
Andrei N. Gerasimov ◽  
Tamara E. Novoselova
Keyword(s):  
Metabolic Syndrome ◽  
Carbohydrate Metabolism ◽  
Medical Records ◽  
Density Lipoprotein ◽  
Homa Index ◽  
Obese Patients ◽  
Hip Circumference ◽  
Metabolically Healthy Obese ◽  
Healthy Obese ◽  
Metabolically Healthy

Introduction. Obesity is a major factor for cardiometabolic risk. However, there is a category of obese patients without disorders of lipid, carbohydrate metabolism and cardiovascular disease metabolically healthy obese (MHO). Aim. Our goal was to investigate the prevalence and characteristics of this phenotype compared to patients with metabolic syndrome (MS). Materials and methods. To evaluate the prevalence of the MHO phenotype we analyzed 389 medical records of females aged 1860 years with obesity. Three types of MHO criteria were used: 1) HOMA index (2.7); 2) IDF-criteria of metabolic syndrome, 2005; 3) the BioSHaRE-EU 2013 criteria (obese patients without any symptoms of MS). We conducted a comparative analysis of anthropometry, status of lipid and carbohydrate metabolism, the functional state of the liver. Results. The MHO prevalence was: 34.5% according to HOMA index, according to the definitions of MS 2005 38.6%, in BioSHaRE-EU 9.6%. In groups of MHO and MS dyslipidemia was observed in 27.3 and 49.5% (p0.05), hypertension in 25% and 71.6% (p0.05), steatogepatosis in 47.7% vs 51.3% (p0.05) of observations, respectively. Among comorbidities the gynecological pathology was most prevalent - 50.8 and 61.4% (p0.05), disorders of carbohydrate metabolism differed significantly in frequency- 6.82 and 39.1% of patients (p0.05). Patients with MHO had a shorter duration of the existence of obesity than MS (18.7 vs. 24 years) (p=0.0004) and less likely to have attempted to reduce weight 85.8% and 91.6%. Average BMI, waist circumference, hip circumference, fasting glucose, total cholesterol, insulin basal, basal C-peptide, HOMA index in groups of MHO and MS differed significantly (p0.05). Median ALT was 20 and 23.2 U/l, AST 20 and 23 U/l, triglycerides 1.1 and 1.8 mmol/l, high-density lipoprotein 1.4 and 1.1 mmol/l, respectively. Conclusions. The MHO prevalence was maximal according to the MS definitions from 2005, and minimal with BioSHaRE-EU criteria. The main analyzed indicators differed significantly in groups MHO and MS. Longer obesity existence in the MS group may suggest an instability of MHO phenotype over time.

scholarly journals Postoperative microcirculatory perfusion and endothelial glycocalyx shedding following cardiac surgery with cardiopulmonary bypass

Anaesthesia ◽  
2019 ◽  
Vol 74 (5) ◽  
pp. 609-618 ◽  
Author(s):  
N. A. M. Dekker ◽  
D. Veerhoek ◽  
N. J. Koning ◽  
A. L. I. Leeuwen ◽  
P. W. G. Elbers ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Endothelial Glycocalyx ◽  
Microcirculatory Perfusion

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.

Effectiveness of bariatric surgery in metabolically healthy obese patients

2018 ◽  
Author(s):  
Laura Tuneu ◽  
Analia Ramos ◽  
Idoia Genua ◽  
Nicole Stantonyonge ◽  
Francisca Caimari ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Obese Patients ◽  
Metabolically Healthy Obese ◽  
Healthy Obese ◽  
Metabolically Healthy

scholarly journals IMMUNOSUPPRESSION AS A COMPONENT OF MULTIPLE ORGAN DYSFUNCTION SYNDROME FOLLOWING CARDIAC SURGERY

2018 ◽  
Vol 7 (4) ◽  
pp. 84-91 ◽  
Author(s):  
E. V. Grigoryev ◽  
D. L. Shukevich ◽  
V. G Matveeva ◽  
R. A. Kornelyuk
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Postoperative Period ◽  
Inflammatory Cytokine ◽  
Suppressor Cells ◽  
Multiple Organ ◽  
Myeloid Derived Suppressor Cells ◽  
Multiple Organ Dysfunction ◽  
Hla Dr ◽  
Anti Inflammatory Cytokine

Aim. To defne the role of myeloid-derived suppressor cells in the development of persistent multiple organ dysfunction followed cardiac surgeries with cardiopulmonary bypass.Methods. 40 patients who have undergone cardiac surgery were included in the study. Granulocyte myeloid-derived suppressor cells (G-MDSC) were defned as cells with the HLA-DR– / CD11β+ / CD15+ / CD33+ phenotype, and monocytic MDSC (M-MDSC) as cells with the HLA-DR– / CD11β+ / CD14+ / CD33+ phenotype using flow cytometry. Levels of cytokines, IL-1β, IL-6, TNF-α, and IL-10 were measured with an enzyme immunoassay. All patients were assigned to three groups: Group 1 – patients with the uncomplicated postoperative period (n = 14), Group 2 – patients with non-persistent MODS and its early resolution (n = 16), and Group 3 – patients with persistent MODS at day 7.Results. We observed an increase in M-MDSCs and G-MDSC at day 1 following cardiac surgery. The most pronounced increase was found in monocytic-myeloid derived suppressor cells, i.e. an 8-fold increase in M-MDSCs in all study groups at day 1 after surgery. The number of M-MDSCs remained high in patients with persistent MODS at day 7 after cardiac surgery. Levels of IL-6 and IL-10 increased at day 1 after surgery. IL-6 reached its peak level, signifcantly exceeding baseline levels. By day 7, blood levels of all cytokines have decreased, except IL-10 levels, which remained above the baseline in patients with persistent MODS.Conclusion. An increase in M-MDSCs and elevated serum levels of the anti-inflammatory cytokine IL-10 have been found in patients regardless of the presence or absence of the complications in the early postoperative period after cardiac surgery with cardiopulmonary bypass. Persistent MODS with the SOFA scoring > 5 scores at day 7 after cardiac surgery, is associated with an increase in M-MDSCs and elevated levels of the anti-inflammatory cytokine IL-10, related to higher rate of hospital infections, prolonged intensive care unit stay and higher mortality.

scholarly journals Are metabolically healthy obese patients also hemorheologically healthy?

2015 ◽  
Vol 61 (1) ◽  
pp. 39-46 ◽  
Author(s):  
Jean-Frédéric Brun ◽  
Emmanuelle Varlet-Marie ◽  
Christine Fedou ◽  
Eric Raynaud de Mauverger
Keyword(s):  
Obese Patients ◽  
Metabolically Healthy Obese ◽  
Healthy Obese ◽  
Metabolically Healthy
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