The use of leucocyte-depleting and conventional arterial line filters in cardiac surgery: a systematic review of clinical studies

Whitaker, Donald; Stygall, Jan; Newman, Stanton; Harrison, Michael J.

doi:10.1177/026765910101600602

Cited by 23 publications

(11 citation statements)

References 39 publications

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“…Such findings are probably responsible for the differences found between the current study and other reports [29]. We believe that definitive guidelines for when to use a leukocyte filter in the CPB circuit still remain to be determined, although some studies have discouraged its routine use [29, 30]. …”

Section: Discussioncontrasting

confidence: 59%

Leukocyte Depletion During CPB: Effects on Inflammation and Lung Function

et al. 2013

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Cardiopulmonary bypass (CPB) is related to inflammatory response and pulmonary dysfunction. The aim of this study was to evaluate the effects of CPB leukocyte filtration on inflammation and lung function after coronary artery bypass grafting (CABG). A prospective randomized study was performed to compare CABG patients undergoing CPB leukocyte filtration (n = 9) or standard CPB (n = 11). Computed tomography, oxygenation, leukocyte count, hemodynamic data, PaO2/FiO2, shunt fraction, interleukins, elastase, and myeloperoxidase were evaluated. Data were analyzed using two-factor ANOVA for repeated measurements. The filtered group showed lower neutrophil counts up to 50 min of CPB, lower shunt fraction up to 6 h after surgery, and lower levels of IL-10 at the end of surgery (p < 0.05). There was no statistically significant difference between groups related to other parameters. Leukodepletion during CPB results in neutrophil sequestration by a short time, decreased IL-10 serum levels, and lower worsening of lung function only temporarily.

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Section: Discussioncontrasting

confidence: 59%

Leukocyte Depletion During CPB: Effects on Inflammation and Lung Function

et al. 2013

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“…Whilst there are previous review articles pertaining to the use of leukocyte filters [18,[30][31][32][33][34] they are either not systematic, or focus on just one strategy or site for the filter. Furthermore, they are dated.…”

Section: Aim and Scope Of Reviewmentioning

confidence: 99%

“…Initially work focused on molecular inflammatory mediators and a wide variety of markers of neutrophil activation [17,22,23]. However, later work measured biochemical markers of organ injury [24][25][26] and examined the impact of leukodepletion on post-operative clinical course and the hospital costs [11,[27][28][29][30].…”

Section: Introductionmentioning

confidence: 99%

The effects of various leukocyte filtration strategies in cardiac surgery

Warren

Alexiou

Massey

et al. 2007

European Journal of Cardio-Thoracic Surgery

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It is known that cardiopulmonary bypass causes an inflammatory reaction with an associated morbidity and mortality. Several anti-inflammatory strategies have been implemented to reduce this response, including leukocyte removal from the circulation using specialised filters. The aim of this study is to systematically review the available evidence on leukocyte filtration in cardiac surgery, focusing on its effect on systemic inflammation and whether this has influenced clinical outcomes. Five electronic databases were systematically searched for studies reporting the effect of leukocyte filtration at any point within the cardiopulmonary bypass circuit in humans. Reference lists of all identified studies were checked for any missing publications. Two authors independently extracted the data from the included studies. Whilst systemic leukodepleting filters do not appear to consistently lower leukocyte counts, they may preferentially remove activated leukocytes. Small improvements in early post-operative lung function in patients receiving systemic leukodepletion have been reported, but this does not lead to reduced hospital stay or decreased mortality. There is substantial evidence that cardioplegic leukocyte filtration attenuates the reperfusion injury at a cellular level, but this has not been translated into clinical improvements. Finally, whilst various strategies involving multiple leukocyte filters, or the incorporation of pharmacological agents into leukocyte-depleting protocols have been evaluated, the current available results are not conclusive. Our study suggests that there is not enough high quality or consistent evidence to draw guidelines regarding the use of leukocyte-depleting filters within routine cardiac surgical practice.

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“…For example, utilizing sheep and pig lung models of I/R, our laboratory demonstrated a significant role for neutrophils (33) and NADPH oxidase (11,12), the major enzymatic source of neutrophil-derived reactive oxygen species (ROS). The contribution of these mechanisms and the underlying sensitivity to I/R, however, appears to vary across different experimental species (1,9,11,12,20,33,36). Some of this variability may result from underlying genetic pressures that interact with environmental factors and confound experimental outcomes.…”

mentioning

confidence: 99%

Strain-specific differences in sensitivity to ischemia-reperfusion lung injury in mice

Dodd‐o

Hristopoulos

Welsh-Servinsky

et al. 2006

Journal of Applied Physiology

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Ischemia-reperfusion (I/R) lung injury is characterized by increased pulmonary endothelial permeability and edema, but the genetic basis for this injury is unknown. We utilized an in vivo mouse preparation of unilateral lung I/R to evaluate the genetic determinants of I/R lung injury. An index of pulmonary vascular protein permeability was measured by the ratio of left-to-right lung Evans blue dye of eight inbred mouse strains after 30 min of left lung ischemia and 150 min of reperfusion. The order of strain-specific sensitivity to I/R lung injury was BALB/c < SJL/J < CBA/J < C57BL/6J < 129/J < A/J < C3H/H3J < SWR/J. The reciprocal F1 offspring of the BALB/c and SWR/J progenitor strains had intermediate phenotypes but a differing variance. A similar pattern of right lung Evans blue dye content suggested the presence of contralateral injury because baseline vascular permeability was not different. Lung I/R injury was attenuated by NADPH oxidase inhibition, indicating a role for NADPH oxidase-derived reactive oxygen species (ROS). There was no strain-dependent difference in lung NADPH oxidase expression. Strain-related differences in zymosan-stimulated neutrophil ROS production did not correlate with I/R lung injury in that neutrophil ROS production in SWR/J mice was greater than C57BL/6J but not different from BALB/c mice. These data indicate the presence of a genetic sensitivity to lung I/R injury that involves multiple genes including a maternal-related factor. Although neutrophil-derived ROS production is also modulated by genetic factors, the pattern did not explain the genetic sensitivity to lung I/R injury.

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The use of leucocyte-depleting and conventional arterial line filters in cardiac surgery: a systematic review of clinical studies

Cited by 23 publications

References 39 publications

Leukocyte Depletion During CPB: Effects on Inflammation and Lung Function

Leukocyte Depletion During CPB: Effects on Inflammation and Lung Function

The effects of various leukocyte filtration strategies in cardiac surgery

Strain-specific differences in sensitivity to ischemia-reperfusion lung injury in mice

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