Cardiopulmonary bypass tubes and prime solutions stimulate neutrophil adhesion molecules

Abstract

Mixing blood with acidic prime solution and/or exposing it to PVC tubes causes up-regulation of neutrophil adhesion molecule CD11b and down-regulation of L-selectin. Neutralisation of the prime solution reduces the extent of neutrophil activation, whereas haemodilution has no effect. Increasing plasma water is stimulating to the neutrophil. Modulation of prime solutions and the material of CPB tubes may reduce neutrophil activation which may reduce patient morbidity.

Air-blood barrier injury during cardiac operations with the use of cardiopulmonary bypass (CPB). An old story?

“…Moreover, this proved that the amount of surfactant which had entered the circulation (across the injured alveolar-capillary barrier) reflected the degree of lung injury. As mentioned previously sequestration of activated neutrophils within the pulmonary microcirculation plays a major role in the so- called "post-pump" syndrome (18). In this investigation we observed several PMN within alveolar blood vessels and some of them within alveolar space (where they can survive up to 6 h).…”

Expression of soluble endothelial adhesion molecules in clinical cardiopulmonary bypass

“…[1][2][3] The interaction of blood products with the artificial surfaces of the extracorporeal circuit activates components of the humoral (complement, kinins, fibrinolytic and coagulation cascade) and cellular (neutrophils, macrophages and platelets) inflammatory cascades and may contribute to this dysfunction. 1,4 Inflammatory mediators including cytokines, arachidonate metabolites, platelet-activating factors and others are released during CPB. [5][6][7][8][9] There is evidence to suggest that the interaction of the neutrophils and monocytes with the endothelium of the microcirculation is central in this inflammatory process.…”

Monitoring of monocyte functional state after extracorporeal circulation: A flow cytometry study

“…A prolonged activation of immune system can lead to postoperative complications (2). This acute phase response depends on contact of blood with the foreign surfaces of the bypass apparatus, on release of tissue damage products as consequence of postischemic reperfusion (3), and on priming solutions and medications (4,5).…”

“…Polymorphonuclear cells, strongly increased in number after cardiovascular surgery, have been considered to play a central role in the development of postoperative complications. So far, many studies have been focused on evaluation of surface adhesion molecules and intracellular enzymatic content of this cell type to predict and monitor the postoperative clinical outcome (5,9,10).…”