The Inflammatory Response to Cardiopulmonary Bypass: Part 1—Mechanisms of Pathogenesis

Warren, Oliver; Smith, Andrew J.; Alexiou, Christos; Rogers, Paula L. B.; Jawad, Noorulhuda; Vincent, Charles; Darzi, Ara; Athanasiou, Thanos

doi:10.1053/j.jvca.2008.08.007

Cited by 304 publications

(289 citation statements)

References 79 publications

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“…Currently, most investigators believe that ischemia-reperfusion injury (IRI) and the release of massive amounts of inflammatory mediators during cardiopulmonary bypass (CPB) and circulatory arrest are responsible for ARDS after cardiac surgery (3)(4)(5)(6). Analysis of risk factors for and the prognosis of postoperative acute respiratory distress syndrome in patients with Stanford type A aortic dissection risks associated with these surgical procedures are therefore much greater than those of other types of AD (7).…”

Section: Introductionmentioning

confidence: 99%

Analysis of risk factors for and the prognosis of postoperative acute respiratory distress syndrome in patients with Stanford type A aortic dissection

2016

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Section: Introductionmentioning

confidence: 99%

Analysis of risk factors for and the prognosis of postoperative acute respiratory distress syndrome in patients with Stanford type A aortic dissection

2016

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“…[106][107][108][109] Conflicting studies exist on the use of steroids after cardiac surgery, some of them reporting a decrease in catecholamine support and a shorter ICU stay. 110,111 Supplementation of 50 mg hydrocortisone iv qid is a place to start when distributive shock persists and the noradrenaline requirement is > 0.3 mcg/kg/min iv.…”

Section: Consider Anti-inflammatory Strategiesmentioning

confidence: 99%

Shock Management For Cardio-Surgical ICU Patients — The Golden Hours

Hauffe¹,

Krüger²,

Béttex³

et al. 2015

Cardiac Failure Review

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Shock in cardio-surgical intensive care unit (ICU) patients is a serious condition with a high morbidity and mortality.1,2 Prompt identification of the underlying conditions and correct management of the lifethreatening physiological deteriorations are crucial to save the patient's life. In daily practice, however, focusing on the main goal -to provide adequate oxygen delivery thereby preventing further organ damage -is often difficult due to multiple influences, distractions, and pending results. Hence, the setting up of priorities is necessary.In addition, many questions arise on how to optimally treat patients in shock: What blood pressure should we target? What fluid should we use and how much? Which vasoactive drug is best and which inotrope? While discussions about these issues can be very fruitful for experts, they risk confusing younger colleagues and nurses at the bedside. Disputes about controversial therapy opinions might consequently delay adequate resuscitation, putting the patient at risk of an adverse outcome. This review aims to give recommendations for the management during the early phase of shock of cardio-surgical patients hospitalised in the ICU. The focus is on the first 6 hours, which are also called 'the golden hours'. Methods Clinical SettingThe cardio-surgical ICU at the University Hospital Zurich is a 12-bed, high-intensity unit that cares for more than 1,100 patients every year.The majority of these critically ill patients undergo cardiac and/or major vascular surgery, most of them being mechanically ventilated and on inotrope/vasopressor support. The unit is part of a successful heart failure programme that includes extracorporeal life support, ventricular assist devices and a heart transplantation service. In order to optimise the initial resuscitation of patients and to avoid adverse effects of inadequate treatment, the consultants of the unit have agreed on treatment recommendations, which are presented here.They are based on current evidence and complemented by clinical experience in areas of uncertainty. Data ExtractionFor this narrative review, a search of the PubMed database and a review of bibliographies from selected articles were performed to identify original data relating to this topic. Key words used for the search were 'shock', 'cardiac surgery', 'critical care', 'inotropes', 'inotropic therapy', 'circulatory support', 'cardiogenic shock' and 'sepsis'. National and international guidelines were reviewed and integrated, e.g. The 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation, 3 The 2014 ESC/ EACTS guidelines on myocardial revascularization 4 and The Surviving Sepsis Campaign guidelines 5 . Articles were scrutinised regarding their study design, population evaluated, interventions, outcomes, and limitations. Finally, personal recommendations were included and highlighted as such to give a comprehensive overview on this topic. Rationale for an Early Management of ShockShock in patients under...

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“…the surgery itself, mandates the use of anti-inflammatory strategies in order to decrease the severity of pulmonary micro-injuries and inflammation (27)(28)(29), although many of these anti-inflammatory approaches have not been as successful as expected (28,29). It has been demonstrated that cardiopulmonary bypass with longer durations (eg, in one study, surgery took more than 77 minutes), increases the risk for postoperative complications including respiratory complications (3, 15, 30, 31).…”

Section: Rajaei S Et Al Postoperative Respiratory Mortality and Morbmentioning

confidence: 99%

“…Older aged patients (age ≥ 70 years old) is among the most important factors which could impose a greater risk on the CABG patients, as they need to be able to tolerate severely decreased levels of systemic oxygenation and systemic hypoxemia after myocardial revascularization (29,30). Therefore, clinicians should administer effective treatments for such patients in order to prevent postoperative respiratory problems, of these, pulmonary recruitment strategies (including positive end expiratory pressure or PEEP) need to be mentioned as the top choice of such strategies (1, 29-34, 36-41).…”

Section: Agementioning

confidence: 99%

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Risk Factors for Postoperative Respiratory Mortality and Morbidity in Patients Undergoing Coronary Artery Bypass Grafting

Rajaei

Dabbagh²

2012

anesthpain

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The Inflammatory Response to Cardiopulmonary Bypass: Part 1—Mechanisms of Pathogenesis

Cited by 304 publications

References 79 publications

Analysis of risk factors for and the prognosis of postoperative acute respiratory distress syndrome in patients with Stanford type A aortic dissection

Analysis of risk factors for and the prognosis of postoperative acute respiratory distress syndrome in patients with Stanford type A aortic dissection

Shock Management For Cardio-Surgical ICU Patients — The Golden Hours

Risk Factors for Postoperative Respiratory Mortality and Morbidity in Patients Undergoing Coronary Artery Bypass Grafting

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