Effects of normothermia versus hypothermia on extravascular lung water and serum cytokines during cardiopulmonary bypass: A randomized, controlled trial

Abstract

Normothermic CPB is not associated with additional inflammatory and related systemic adverse effects regarding cytokine production and EVLWI as compared with mild hypothermia. The potential temperature-dependent release of cytokines and subsequent inflammation has not been observed and normothermic CPB may be seen as a safe technique regarding this issue.

Effect of myocardial protection and perfusion temperature on production of cytokines and nitric oxide during cardiopulmonary bypass

“…These results reinforce previous reports 2,3 . We also showed that peak levels of all cytokines occurred 4 h after the end of bypass, again concordant with other studies 3,5,6 . It is important to note that the groups in our study presented similar general characteristics, intraoperative parameters, and mortality rates.…”

“…The effect of perfusion temperature and cardioplegia type during bypass on the development of SIRS has been investigated previously, but results are unclear. Some reports did not find differences in serum cytokine levels between patients with normothermic and hypothermic bypass 5,14 , while others found a more rapid decline in IL-8 plasma levels in the former 6 . The use of blood cardioplegia, compared to crystalloid cardioplegia, has been mainly associated with increased myocardial protection.…”

“…The inability to produce sufficient NO during early reperfusion in CPB that is caused by temporary endothelial cell dysfunction may be related to vasospasm that occurs with ischemia and reperfusion 4 . The CPB procedure can be performed under normothermic or hypothermic conditions, and these perfusion temperatures do not appear to affect the degree of inflammatory response or hemodynamics produced 5,6 . However, more recently, it was reported that correcting perioperative hypothermia decreases mortality in experimental sepsis which is associated with reduced IL-6 levels 7 .…”

Transpulmonary Thermodilution: Its Role in Assessment of Lung Water and Pulmonary Edema

“…In an attempt to provide an estimate of pulmonary vascular permeability ratios of EVLW to TPTD derived blood volumes have been utilized. These ratios are intended to reflect EVLW in the context of, or indexed to preload, and were first described in 2001 by Honore et al 72 . The concept is intuitive; a high EVLW in a hypovolemic patient (and therefore an elevated ratio) would suggest capillary permeability is the primary pathology whilst low EVLW in a patient with elevated preload (and therefore a low ratio)…”

Normothermal or Hypothermal Extracorporeal Circulation Regimens in Patients with Acquired Heart Disease

“…Мы не оп ределяли концентрацию провоспалительных и проти вовоспалительных цитокинов. Мы изучали влияние только умеренной гипотермии, которая наиболее широ ко используется в кардиохирургии [35]. Было показано, что глубокая гипотермия (28°C) не обладает преимуще ством перед умеренной гипотермией у пациентов при реваскуляризации миокарда в условиях искусственного кровообращения [36].…”