The effect of air exposure on leucocyte and cytokine activation in an in-vitro model of cardiotomy suction

Toomasian, Cory J.; Aiello, Salvatore; Drumright, Benjamin L; Major, Terry C.; Bartlett, Robert H.; Toomasian, John M

doi:10.1177/0267659118766157

Cited by 17 publications

(11 citation statements)

References 33 publications

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“…Кардиохирургическая операция за счет таких факторов, как искусственное кровообращение (ИК), кардиоплегический арест, транзиторная управляемая глобальная и локальная ишемия и реперфузия, является классической клинической моделью формирования первичного неинфекционного системного воспалительного ответа (СВО) [1]. Триггерными факторами СВО в данной модели являются контакт крови с неэндотелизированной поверхностью экстракорпорального контура, воздействие роликового или центрифужного насосов, гемодилюция, гипотермия, кавитации крови в области канюляции, дисбаланс факторов свертывания, воздействие фармакологических препаратов, используемых для проведения анестезиологического пособия и стабилизации гемостаза, что обусловливает высвобождение различных медиаторов воспаления, а это в совокупности с глобальными факторами и событиями (острая кровопотеря, потребность в повторной окклюзии аорты, повторный эпизод ИК) ведет к развитию полиорганной недостаточности (ПОН) [2][3][4]. Значимый вклад в развитие СВО вносят и трансфузионные триггеры [5], эпизоды гипоперфузии тканей [6].…”

Section: Introductionunclassified

Immunosuppressive profile of patients operated for acquired heart diseases under artificial circulation. A prospective study

Матвеева

Khanova

Ивкин

et al. 2020

Annals of Critical Care

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Objective. To study the dynamics of immunosuppressive cell populations in patients who underwent heart valve replacement surgery under artificial circulation. Materials and methods. We investigated the dynamics of MDSC, PD-1-positive cells among Th and Tcyt and PD-L1-positive monocytes in patients operated on for the heart under cardiopulmonary bypass in the volume of prosthetic heart valves, the study points were before surgery, immediately after surgery and after 1, 3, 7 days. The study was carried out on a CytoFlex laser flow cytometer. Results. In the group of patients without complications and in the group with complications outside the infection, an increase in all MDSC populations was observed 1 day after surgery, with a return to baseline values within a week. The dynamics of MDSC in a patients with sepsis was characterized by an increase within 3 days with the achievement of maximum figures in comparison with the previous groups. In patients without complications, an increase in PD-L1+, PD-1+ CD4+ and PD-1+CD8+ monocytes were observed immediately after surgery and one day later. In the case of the development of infectious complications in the postoperative period, a relatively moderate increase in the monocyte content was observed only by 3 days after the operation. The content of PD-1 positive T cells increased moderately up to 7 days among Th, and significantly by 7 days, followed by a decrease among Tcyt. Conclusions. A high initial content of Mon-MDSC is a risk factor for the development of postoperative infectious complications. A significant increase in immunosuppressive populations in the early postoperative period can be regarded as an unfavorable variant of the course of the compensatory anti-inflammatory syndrome.

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Section: Introductionunclassified

Immunosuppressive profile of patients operated for acquired heart diseases under artificial circulation. A prospective study

Матвеева

Khanova

Ивкин

et al. 2020

Annals of Critical Care

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“…Все эти факторы, конечно же, присущи и операциям по коррекции врожденных пороков сердца у детей, но их отличает, во-первых, большой объем вмешательства и травмы тканей, а во-вторых, то, что в большинстве случаев проводятся они в условиях искусственного кровообращения (ИК). При этом ИК сопряжено с целым рядом патогенных факторов: контакт крови с поверхностью контура аппарата ИК и воздушной средой в кардиотомном резервуаре, гемодилюция, воздействие роликовых насосов на форменные элементы крови, непульсирующий кровоток [2][3][4]. Все это вкупе с другими факторами выступает источником запуска первой фазы развития СВО с участием гуморального (система комплемента, коагуляционное звено, выброс цитокинов) и клеточного ответа (активация лейкоцитов, тромбоцитов).…”

Section: The Effect Of Erythrocyte-containing Donor Blood Components ...unclassified

“…Концентрация креатинина в крови в послеоперационном периоде составляла: 26,5 мкмоль/л [19, в ИГ и 32,5 мкмоль/л [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] в КГ (р=0,015). Концентрация мочевины в крови: 3,7 ммоль/л [3,1-4,9] среди пациентов ИГ и 4,5 ммоль/л [4][5]5] Концентрация ИЛ-10 значимо увеличилась относительно исходных значений (ИГ -0,62 нг/мл; КГ -0,62 нг/мл) после завершения ИК (ИГ -7,92 нг/мл; КГ -8,78 нг/мл) (р<0,001). Однако, на следующие сутки в ИГ она (0,69 нг/мл) уже значимо не не отличалась от исходной (р=0,49), в отличие от КГ (0,8 нг/мл), где она была значимо выше (р=0,006).…”

Section: результаты и обсуждениеunclassified

The Eﬀect of Erythrocyte-Containing Donor Blood Components in the Priming of the Cardiopulmonary Bypass Circuit on the Development of Systemic Inﬂammation During Correction of Congenital Heart Defects in Children

Борисенко

Ивкин

Шукевич

et al. 2022

Obŝaâ reanimatologiâ

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Various pathological factors accompanying any cardiac surgery can cause intraoperative systemic inﬂammatory responses (SIR). As the number of cardiac surgical interventions grows worldwide, the issue of SIR prevention appears highly relevant.Aim of the study. To determine the eﬀect of not using donor blood components in the priming of the cardiopulmonary bypass circuit in children with septal congenital heart defects, operated under cardiopulmonary bypass, on the severity of SIR.Material and methods. A prospective, randomized study included 40 children with a median age of 14 [12–22.5] months and weight of 8.8 [7.25–11] kg. All patients underwent radical correction of septal defect under cardiopulmonary bypass. The patients were divided into two groups depending on the use of donor blood components for priming the CPB. The severity of SIR was assessed using four speciﬁc serum biomarkers such as interleukin 1b (IL-1b), interleukin 6 (IL-6), interleukin 10 (IL-10), and tumor necrosis factor alpha (TNF-α), measured before the operation, after the CPB and 16 hours after the surgery. In addition, the intra- and postoperative periods were evaluated.Results. The safety of the proposed strategy of skipping the donor blood was confirmed by lack of any organ dysfunction in all patients, as well as a significant difference in the balance of oxygen delivery and consumption. In addition, the levels of systemic inflammation markers after CPB were significantly higher in patients who had transfusion: IL-1b was 3.3 [3.2–3.48] pg/mL vs 2.86 [2.7–3.11] pg/mL (P=0.003) and TNF-α reached 1.81 [1.37–3.3] pg/mL vs 1.33 [1.26–1.76] pg/mL (P=0.034). Meanwhile, 16 hours post surgery, IL-6 and IL-10 levels were significantly higher in the group using donor blood components with IL-6 being 48.91 [33.89–57.6] pg/mL vs 31.56 [26.83–48.89] pg/mL (P=0.087) and IL-10 reaching 0.8 [0.76–1.43] pg/mL vs 0.69 [0.6–0.83] pg/mL (P=0.005).Conclusion. The study demonstrates and conﬁrms the safety and eﬃcacy of cardiopulmonary bypass without using donor blood components to reduce the severity of the systemic inﬂammatory response in children undergoing correction of septal congenital heart defects.

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“…They were also required to have had a cardiac surgery with cardiopulmonary bypass, whose specific condition is associated with the risk of deficit of gas diffusion through the alveolar-capillary barrier. Cardiopulmonary bypass may activate proinflammatory cells in the body system after blood exposure to the bio-incompatible surface of the artificial blood circulation [23].…”

Section: Patientsmentioning

confidence: 99%

Patient-ventilator asynchrony in conventional ventilation modes during short-term mechanical ventilation after cardiac surgery: randomized clinical trial

et al. 2020

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Introduction and aim: Studies regarding asynchrony in patients in the cardiac postoperative period are still only a few. The main objective of our study was to compare asynchronies incidence and its index (AI) in 3 different modes of ventilation (volume-controlled ventilation [VCV], pressure-controlled ventilation [PCV] and pressure-support ventilation [PSV]) after ICU admission for postoperative care. Methods: A prospective parallel randomised trial in the setting of a non-profitable hospital in Brazil. The participants were patients scheduled for cardiac surgery. Patients were randomly allocated to VCV or PCV modes of ventilation and later both groups were transitioned to PSV mode. Results: All data were recorded for 5 minutes in each of the three different phases: T1) in assisted breath, T2) initial spontaneous breath and T3) final spontaneous breath, a marking point prior to extubation. Asynchronies were detected and counted by visual inspection method by two independent investigators. Reliability, inter-rater agreement of asynchronies, asynchronies incidence, total and specific asynchrony indexes (AIt and AIspecific) and odds of AI ≥10% weighted by total asynchrony were analysed. A total of 17 patients randomly allocated to the VCV (n= 9) or PCV (n=8) group completed the study. High inter-rated agreement for AIt (ICC 0.978; IC95%, 0,963-0.987) and good reliability (r=0.945; p<0.001) were found. Eighty-two % of patients presented asynchronies, although only 7% of their total breathing cycles were asynchronous. Early cycling and double triggering had the highest rates of asynchrony with no difference between groups. The highest odds of AI ≥10% were observed in VCV regardless the phase: OR 2.79 (1.36-5.73) in T1 vs T2, p=0.005; OR 2.61 (1.27-5.37) in T1 vs T3, p=0.009 and OR 4.99 (2.37-10.37) in T2 vs T3, p<0.001. Conclusions: There was a high incidence of breathing asynchrony in postoperative cardiac patients, especially when initially ventilated in VCV. VCV group had a higher chance of AI ≥10% and this chance remained high in the following PSV phases.

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The effect of air exposure on leucocyte and cytokine activation in an in-vitro model of cardiotomy suction

Cited by 17 publications

References 33 publications

Immunosuppressive profile of patients operated for acquired heart diseases under artificial circulation. A prospective study

Immunosuppressive profile of patients operated for acquired heart diseases under artificial circulation. A prospective study

The Eﬀect of Erythrocyte-Containing Donor Blood Components in the Priming of the Cardiopulmonary Bypass Circuit on the Development of Systemic Inﬂammation During Correction of Congenital Heart Defects in Children

Patient-ventilator asynchrony in conventional ventilation modes during short-term mechanical ventilation after cardiac surgery: randomized clinical trial

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