The overall incidence of TEE complications after cardiac surgery was 1.4%. Advanced age, low body mass index, complexity of procedure, prior stroke, prolonged bypass time, and return to the operating room appear to be significant risk factors for TEE complications.

Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are major causes of morbidity and mortality in the intensive care unit, but despite continuing research few effective therapies have been identified. In recent years, inhaled carbon monoxide (CO) has been reported to have cytoprotective effects in several animal models of tissue injury. We therefore evaluated the effects of inhaled CO in three different in vivo mouse models of ALI. Anesthetized C57BL/6 mice were ventilated with oxygen in the presence or absence of CO (500 parts per million) for 1 h before lung injury was induced by lipopolysaccharide (LPS) or oleic acid (OA) administration. Ventilation was then continued with the same gases for a further 2-3 h, with hemodynamic and respiratory parameters monitored throughout. Intratracheal LPS administration induced lung injury with alveolar inflammation (increased lavage fluid neutrophils, total protein, and cytokines). In contrast, intravenous LPS induced a predominantly vascular lung injury, with increased plasma TNF and increased neutrophil activation (surface Mac-1 upregulation and L-selectin shedding) and sequestration within the pulmonary vasculature. Intravenous OA produced deteriorations in lung function, reflected by changes in respiratory mechanics and blood gases and lavage fluid neutrophil accumulation. However, addition of CO to the inspired gas did not produce significant changes in the measured physiological or immunological parameters in the mouse models used in this study. Thus the results do not support the hypothesis that use of inhaled CO is beneficial in the treatment of ALI and ARDS. cytokines; lipopolysaccharide; oleic acid; neutrophil recruitment; pulmonary inflammation ACUTE LUNG INJURY (ALI) and its more severe form acute respiratory distress syndrome (ARDS) are major causes of mortality and morbidity in the intensive care unit. These syndromes are characterized by the development of hypoxemia, alveolar-capillary barrier damage, and pulmonary inflammation, occurring within hours to days of a predisposing insult, which may be of either pulmonary (e.g., pneumonia, aspiration of gut contents) or extrapulmonary (sepsis, acute pancreatitis) nature (32). Despite intense research, few studies have identified therapies that show a beneficial impact on the outcome of ALI, with the exception of the use of lung protective ventilatory strategies (1, 2).Carbon monoxide (CO) has long been known in biology and medicine as a toxic compound, due to its ability to bind hemoglobin with a much higher affinity than oxygen (25). Despite this image as a deadly gas, recent evidence indicates that CO may in fact have a cytoprotective function at low doses. CO is endogenously produced during heme metabolism by the enzyme heme oxygenase, which is one of the major antioxidant cytoprotective enzymes within the body (17,22). Several investigators have reported that exogenously administered CO by inhalation may exert anti-inflammatory effects, providing protection in various animal models of tiss...

The primary objectives of this article are to review the potential role of carbon monoxide (CO) as an endogenous mediator, diagnostic marker for pulmonary disorders, and therapeutic target in critical illness. The review will start by focusing on the importance of the heme oxygenase (HO)-CO axis as an endogenous system as it relates to the cardiovascular and pulmonary systems. It will elucidate the influence of HO gene expression on critical events like shock, sepsis, ischemia-reperfusion and others. Our focus will then shift and look at the potential diagnostic role of exhaled CO in major inflammatory states of the lung, and finally we will highlight the activities on inhaled CO being considered as a possible therapeutic tool and the controversies surrounding it.

PE led to OS that was augmented following TL. Decreased adhesion molecule expression of circulating leukocytes in the early phase of TL reflects the pathological leukocyte endothelial cell interactions.