Endotoxins in cardiopulmonary bypass

Nilsson, Leif; Kulander, Lena; Nyström, Sven-Olov; Eriksson, Ola

doi:10.1016/s0022-5223(19)35477-7

Cited by 77 publications

(18 citation statements)

References 15 publications

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“…A significant portion of morbidity and mortality observed following cardiac surgery has been proposed to be due to an inflammatory response induced by endotoxin [2][3][4]. Endotoxin is produced by intestinal flora and is normally confined to the lumen of the intestine.…”

Section: Discussionmentioning

confidence: 99%

“…Hence, Brands et al describe the use of alkaline phosphatase for the prophylaxis or treatment of LPS mediated diseases [17]. However, the reported circulating endotoxin concentrations and the duration of exposure to endotoxin and subsequent pro-inflammatory response vary among different articles and may depend on methodology used at the clinical site [3,18]. Once in the circulation, excess of endotoxin levels induces inflammatory cytokines provoking an inflammatory response and ultimately activation of e.g.…”

Section: Discussionmentioning

confidence: 99%

“…Endotoxin is produced by intestinal flora and is normally confined to the lumen of the intestine by a barrier of endovascular cells. During cardiopulmonary bypass (CPB) mesenteric hypoperfusion occurs which results in a loss of barrier function and as a consequence bacterial endotoxins may enter the systemic circulation [2,3]. The amount of endotoxin in the systemic circulation appears to be related to CPB time and also to cross clamp time [4].…”

Section: Introductionmentioning

confidence: 99%

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Anti-Inflammatory Effects of Alkaline Phosphatase in Coronary Artery Bypass Surgery with Cardiopulmonary Bypass

Kats

Brands²,

Seinen³

et al. 2009

IAD

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Laboratory and clinical data have implicated endotoxin as an important factor in the inflammatory response to cardiopulmonary bypass. Alkaline phosphatase prevents endotoxin-induced systemic inflammation in animals and humans. We assessed the effects of the administration of bovine intestinal alkaline phosphatase on surgical complications in patients undergoing coronary artery bypass grafting. In a double blind, randomized, placebo-controlled study, a total of 63 patients undergoing coronary artery bypass grafting were enrolled. Bovine intestinal alkaline phosphatase or placebo was administered as an intravenous bolus followed by continuous infusion for 36 hours. The primary endpoint was reduction of post-surgical inflammation. No significant safety concerns were identified. The overall inflammatory response to coronary artery bypass grafting with cardiopulmonary bypass was low in both placebo and bovine intestinal alkaline phosphatase patient group. Five patients in the placebo group displayed a significant TNFalpha response followed by an increase in plasma levels of IL-6 and IL-8. Such a TNFalpha response was not observed in the bovine intestinal alkaline phosphatase group, suggesting anti-inflammatory activity of bovine intestinal alkaline phosphatase. Other variables related to systemic inflammation showed no statistically significant differences. Bovine intestinal alkaline phosphatase can be administered safely in an attempt to reduce the inflammatory response in coronary artery bypass grafting patients with a low to intermediate EuroSCORE. The anti-inflammatory effects might be more pronounced in patients developing more fulminant postoperative inflammatory responses. This will be investigated in a further trial with inclusion of patients undergoing complicated cardiac surgery, demanding extended cardiopulmonary bypass and aortic cross clamp time. In this review article some recent patents related to the field are also discussed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Anti-Inflammatory Effects of Alkaline Phosphatase in Coronary Artery Bypass Surgery with Cardiopulmonary Bypass

Kats

Brands²,

Seinen³

et al. 2009

IAD

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“…Atendo-se particularmente aos componentes de circulação extracorpórea contemplados pelos componentes poliméricos de escolha para o presente trabalho, deve-se salientar a afinidade entre endotoxinas e material plástico, relatada por Sawada e col. 14 , embora discordante dos dados obtidos por Roslansky e col. 12 para polipropileno e poliestireno. Associando ao conhecimento expresso por Nilsson e col. 11 , que enfatizam a importância da análise de endotoxinas ligadas à superfície polimérica, que ainda assim induzem a reações de ativação do complemento, justifica atenção particular a este segmento, buscando a garantia na liberação destes correlatos livres da presença de endotoxinas. O peróxido de hidrogênio foi há muitos anos considerado efetivo na destruição de endotoxinas, dependendo de concentração, tempo de contato e temperatura 2,10,16 , embora sem elucidação completa do mecanismo da reação 3,6,7 .…”

Section: Discussionunclassified

Peróxido de hidrogênio como agente despirogenizante de componentes para produtos médico-hospitalares

Pinto

1995

Rev. Saúde Pública

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The current search for alternative solvents to fluorinated products, in face of the depletion of ozone in the stratosphere calls for the development of alternative processes applicable to the manufacture of medical devices. In view of the challenge and as water is serving particularly as the choice for other industrial segments, the fast macrobial proliferation in it is of concern, as it is a potential source of endotoxins. Such a risk is inconsistent with the production of items designed for example, for use in surgical procedures in the cardio-vascular field. Thus research was undertaken for the purpose of investigating the possibility of using water as a cleansing agent for components for such products, providing that hydrogen peroxide is added. The work was carried out by inoculating water and peroxide at levels of 0.1, 0.25, 0.5 e 1.0 UE/ml. The confirmation was obtained as to the active effectiveness at a 5% concentration of hydrogen peroxide by means of analytical determination using the "in vitro" method. The effectiveness of the use of peroxide was investigated on polycarbonate injected parts designed for the manufacture of oxigenators and blood reservoirs and contained with endotoxins. The findings permit one to draw a favorable conclusion regarding the adequacy of the proposed process both biologically as well as regards the removal of impurities.

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“…A reação do sistema humoral e celular decorrente do uso da CEC é semelhante à reação produzida pelas endotoxinas nas sepses gram-negativas (4,7,8) . Estudos têm demonstrado a presença de endotoxinas na CEC (9,10) .…”

Section: Introductionunclassified

Uso de corticóide como inibidor da resposta inflamatória sistêmica induzida pela circulação extracorpórea

Brasil¹,

Gomes²,

Salomão³

et al. 1999

Rev Bras Cir Cardiovasc

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RESUMO: A circulação extracorpórea (CEC) propicia o desenvolvimento de uma Síndrome de Resposta Inflamatória Sistêmica, com liberação de citocinas responsáveis por várias manifestações clínicas. Objetivo: Observar a liberação das citocinas Fator de Necrose Tumoral Alfa (TNFα) e Interleucina 6 (IL-6) e verificar as alterações clínicas produzidas em pacientes submetidos à revascularização do miocárdio com CEC, utilizando ou não corticóide. Casuística e Métodos: Foram estudados 30 pacientes, sendo 15 (Grupo I) com uso de corticóide (Metilprednisolona, 30 mg/kg) e 15 (Grupo II) sem uso de corticóide. Amostras sangüíneas seriadas foram colhidas, sendo analisadas a liberação de TNFα e IL-6, contagem de leucócitos, VHS e glicemia. Foram comparadas a pressão arterial, freqüência cardíaca, temperatura, sangramento pós-operatório, tempo de intubação orotraqueal e necessidade de drogas vasoativas. Na análise estatística foram considerados significativos valores de p ≤ 0,05. Resultados: No Grupo I o TNFα não foi detectado e a IL-6 foi detectada em 13 pacientes, com níveis variando de 8,6 a 101,8 pg/ml. No Grupo II o TNFα foi detectado em 13 pacientes, com níveis entre 5,4 e 231,0 pg/ml. A IL-6 neste grupo foi detectada nos 15 pacientes, sendo seus níveis mais elevados que aqueles encontrados no Grupo I, variando entre 5,5 e 2569,0 pg/ml. Os pacientes do Grupo I apresentaram pressão arterial média mais elevada (7,9 ± 0,5 vs 7,3 ± 0,4 mmHg), menor necessidade de drogas vasoativas (5 vs 11). Evoluíram com menos taquicardia (105,6 ± 5,9 vs 109,3 ± 7,2 bpm), temperatura menos elevada (36,5 ± 0,2 vs 37,3 ± 0,2 °C), menor sangramento pós-operatório (576,6 ± 119,5 vs 810,0 ± 176,2 ml), menor tempo de intubação orotraqueal (11,0 ± 2,0 vs 14,6 ± 2,9 h) e leucocitose menos acentuada. Os níveis de glicemia só foram significativos (Grupo I > Grupo II) nas amostras colhidas no PO imediato e 1º PO. O VHS não apresentou diferença estatisticamente significativa entre os dois grupos. Conclusões: A metilprednisolona inibiu significantemente a liberação de citocinas pró-inflamatórias principalmente o TNFα. Os efeitos sistêmicos adversos decorrentes da reação inflamatória pós-CEC foram atenuados com o uso do corticóide. DESCRITORES: Revascularização miocárdica. Circulação extracorpórea, efeito adverso. Corticóides, farmacologia. Síndrome séptica, etiologia. IL6, antagonistas & inibidores. TNF-alfa, antagonistas & inibidores.

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Endotoxins in cardiopulmonary bypass

Cited by 77 publications

References 15 publications

Anti-Inflammatory Effects of Alkaline Phosphatase in Coronary Artery Bypass Surgery with Cardiopulmonary Bypass

Anti-Inflammatory Effects of Alkaline Phosphatase in Coronary Artery Bypass Surgery with Cardiopulmonary Bypass

Peróxido de hidrogênio como agente despirogenizante de componentes para produtos médico-hospitalares

Uso de corticóide como inibidor da resposta inflamatória sistêmica induzida pela circulação extracorpórea

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