Leukocyte Filtration Ameliorates the Inflammatory Response in Patients With Mild to Moderate Lung Dysfunction

Clinical Evaluation of New Generation Oxygenators With Integrated Arterial Line Filters for Cardiopulmonary Bypass

“…Finally, the efficacy of hs‐CRP, as a marker of the systemic inflammatory response to CPB after cardiac surgery, and its prognostic role for cardiovascular mortality and morbidity, have been well documented (31). As mentioned above, both the better biocompatibility of the phosphorylcholine coating and the potential better GME removal—with a lower multiorgan ischemia/reperfusion injury—may help to explain the lower inflammation found in Group‐S (4,14,15,28). Furthermore, the lower hs‐CRP leakage in the Sorin group may help to explain its better hemocoagulative profile, given the direct link between inflammatory and coagulative/fibrinolytic cascades (32).…”

“…All patients were cooled to moderate hypothermia, ranging from 32 to 34°C. Cardiac arrest and myocardial protection were accomplished by means of aortic cross‐clamping coupled with intermittent antegrade and retrograde hyperkalemic cold blood cardioplegia (1:4 ratio), followed by a retrograde “hot shot” immediately before aortic declamping, as already reported (15). Repeated doses were administered every 20 min.…”

“… PaO 2 , FiO 2 , and PaCO 2 , derived from blood gas analysis (RapidLab1265 AutomaticQC Cartridge, Siemens Healthcare Italia, Milan, Italy) and sampled from the arterial line during CPB and from the cannulated peripheral radial artery thereafter, at T0: preoperative, T1: at the start of CPB, T2: immediately before CPB discontinuation, T3: at the end of surgery, T4: 3 h, T5: 24 h postoperatively. Blood hematocrit (Ht) was collected at T0 (preoperative) and at T1–T5 as for PaO 2 . Red blood cells (RBCs), PLT count, INR, activated partial thromboplastin time (aPTT), fibrinogen (FBG), and creatinine (Creat) were derived from peripheral blood sampling at T0–T3 as for WBC. Serum albumin and total plasma proteins were assayed at T0 (preoperative), T1 (end of CPB), T2 (end of surgery), and T3 (24 h postoperatively). Pressure drop (in mm Hg) across the two different oxygenators was measured at 10 (T1), 20 (T2), 40 (T3), and 60 (T4) min of CPB run. Static and dynamic priming of the two groups. Total intraoperative volume load, defined as the total amount of volume administered to the patients (Volume‐In), the total amount of volume lost by the patient (Volume‐Out), and the delta (ΔVolume) between Volume‐In and Volume‐Out during the intraoperative time course. Postoperative bleeding, defined as the total amount of chest drain loss at 3 (T0), 6 (T1), 12 (T2), and 24 h (T3) postoperatively Transfusions, defined as the volume of allogeneic red packed cells, plasma, PLTs, and total volume of transfusions per patient. Clinical outcome was defined by intubation time (expressed in hours), ICU length of stay and hospital length of stay (expressed in days), hospital mortality, incidence of perioperative acute myocardial infarction, acute lung injury, acute respiratory insufficiency, acute renal insufficiency, acute renal failure, and type II neurologic complications, as already reported elsewhere (15). All these outcome variables were defined according to the current literature (15). …”

“…Clinical outcome was defined by intubation time (expressed in hours), ICU length of stay and hospital length of stay (expressed in days), hospital mortality, incidence of perioperative acute myocardial infarction, acute lung injury, acute respiratory insufficiency, acute renal insufficiency, acute renal failure, and type II neurologic complications, as already reported elsewhere (15). All these outcome variables were defined according to the current literature (15).…”

The Role of Thoracotomy in the Postoperative Inflammatory Mechanism

“…Further, Newall and coworkers reported that WBC counts were high in patients with chronic obstructive respiratory diseases after coronary artery bypass grafting [4]. The use of leukocyte filtration was recommended to attenuate lung damage after cardiac surgery [6]. In patients with surgically treated facial fractures, leukocytosis was associated with neutrophilia and was verified in the immediate postoperative period [7].…”