Effects of leukocyte-depleted intraoperative salvaged blood on lung injury in patients undergoing major operation with massive bleeding

Objective To investigate the effects of reinfusion of leukocyte-depleted intraoperative salvaged blood on lung injury in patients undergoing major operation with massive bleeding. Methods Twenty four patients undergoing major operation that was anticipated to cause massive bleeding during operation including large liver hemangioma and closed liver and spleen rupture were randomly divided into 2 groups (n=12,in each group):control group (group C) and leukocyte depletion group (group T). Anesthesia was induced with midazolam,fentanyl,propofol and succinyl choline and maintained with isoflurane inhalation and intermittent iv boluses of fentanyl and vecuronium. The patients were mechanically ventilated after tracheal intubation (VT =8~10ml/kg,RR=12bpm,I∶ E = 1∶2). Radial artery and right interval jugular vein were cannulated for continuous BP and CVP monitoring and blood sampling. Intraoperative blood salvage and reinfusion were performed in all patients by using cell saver system. In group T the salvaged blood was fittered with a leukocyte depleting filter placed in the line of the reinfusion circuit. Blood samples were taken from radial artery immediately before the shed blood was reinfused (baseline) and at 30 min,60 min,6 h and 12 h after reinfusion for detecting the plasma concentration of TNF-α,IL-6,IL-8,NE,MDA and SOD activity,total leukocyte count,and blood gas analysis.Respiratoryindex(RI) and pulmonary compliance(CL)were calculated. Results As compared with those in group C,the WBC and PMN counts were significantly decreased compared with the baseline values in group T at different time points after autoblood retransfusion,the plasma concentrations of NE,MDA,TNF-α,IL-6,IL-8 and RI significantly decreased (P0.05),however,the activity of SOD and CL in group T were higher than those in group C.Conclusion Reinfusion of leukocyte-depleted intraoperative salvaged blood can reduce acute lung injury caused by reinfusion of intraoperative salvaged blood.