Influence of two different treatment of banked red blood cells on the inflammatory factor levels and lung function after cardiopulmonary bypass in infants
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Abstract:
Objective
Observe the influence of processing of banked red blood cells(RBCs) with cell saver compared with zero-balanced ultrafiltration(Z-BUF) on the inflammatory factor levels and lung function after cardiopulmonary bypass(CPB) in infants.
Methods
60 infants with ventricular septal defect were randomly divided into control group(A), experimental group(B) and experimental group(C). Banked RBCs washed with cell saver before priming in B, in C the banked RBCs were treatment with Z-BUF and in A the banked RBCs primed directly without any treatment.The levels of tumor necrosis factor(TNF-α), interlecukin-6(IL-6), interlecukin-8(IL-8) and interlecukin-10(IL-10) in arterial blood were decected and comparative analyze the differences between and among three groups.The lung functional parameters, mechanical ventilation time and ICU monitoring time at specific time points of three groups were measured and compared.
Results
The levels of TNF-α, IL-6, IL-8, IL-10 after CPB in B and C were significantly lower than that in group A(P<0.05), between B and C, the levels of inflammatory factors in B were more lower(P<0.05). The functional parameters post-CPB of B and C were significantly improved compared with A(P<0.05) and the B and C's mechanical ventilation time, ICU monitoring time were more shorter(P<0.05). B and C in comparison, the former lung functiona improved more obviously(P<0.05).
Conclusion
Treatment of banked RBCs with cell saver and Z-BUF can reduce the inflammatory factor levels after CPB in infants and relieve systemic inflammatory response, improve lung function, short mechanical ventilation time and ICU monitoring time, by comparison, the former is better than the latter.
Key words:
Red blood cells(RBCs); Cell saver; Zero-balanced ultrafiltration(Z-BUF); Cardiopulmonary bypass(CPB); Inflammatory factors; Lung functionKeywords:
Priming (agriculture)
Group B
Group A
Objective To study the protective effects and mechanism of intermittent ventilation on lung injury during cardiopulmonary bypass(CPB). Methods Twenty-four patients with rheumatic heart disease (RHD) were divided into two groups with random number table: treatment group (n=13),given intermittent ventilation once every 5 minutes during CPB; control group (n=11),no ventilation during CPB. Blood samples were obtained preoperatively. A bronchoalveolar lavage was performed at 2 hours after CPB. The numbers of granulocytes, total protein (TP) and tumor necrosis factor-alpha(TNF-α) content in the bronchoalveolar lavage fluids(BALF) were measured, and lung oxygenate index (OI) were measured preoperatively and 1 hour, 4 hours after CPB termination,respectively. Results The numbers of granulocytes, TP and TNF-α content of treatment group in the BALF were significantly lower than those of the control group (P0.01, P=0.02,0.02),and the lung OI of treatment group at 1 hour and 4 hours after CPB termination was also significantly lower than that of the control group(P0.05); a significant increase of lung OI occurred in both groups at 1 hour and 4 hours after CPB when compared with the same group at baseline before CPB(P0.05). Conclusion Intermittent ventilation has the protective effects on lung injury during CPB by decreasing granulocytes adhesion and alleviating lung inflammatory reaction and endothelial cells injury.
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Blood priming is necessary for cardiopulmonary bypass (CPB) in neonates to avoid excessive hemodilution; however, transfusion-related inflammation affects postCPB outcomes in neonatal open-heart surgery. We hypothesized that ultrafiltration of priming blood before CPB may reduce inflammatory mediators in priming blood and postCPB inflammatory responses, thereby improving cardiopulmonary function. Twelve 1-week-old piglets (3.5 +/- 0.2 kg) were divided into two groups. Group U (n = 6) employed the priming blood ultrafiltrated before CPB, but group N (n = 6) used the nonultrafiltrated blood. Cardiopulmonary bypass was performed for 2 hours and then modified ultrafiltration (MUF) was conducted. Data were acquired before CPB and after MUF. The values of K+, serotonin, and IL-8 in priming blood was significantly decreased after ultrafiltration (8.2 +/- 2.6 vs. 4.2 +/- 0.8 mEq/L, p < 0.01, 234 +/- 96 vs. 74 +/- 42 ng/ml, p < 0.01, 78.4 +/- 5.1 vs. 64.5 +/- 59.1 pg/ml, p < 0.05). Group U after MUF had lower thrombin-antithrombin complex levels (23.9 +/- 5.1 vs. 33.7 +/- 4.6 ng/ml, p < 0.01) and lower IL-8 levels in airway fluid (925 +/- 710 vs. 2495 +/- 1207 pg/ml, p < 0.05) than group N. Cardiac output and arterial PO2 after MUF in group U were also higher (1.13 +/- 0.21 vs. 0.69 +/- 0.22, p < 0.01, 340 +/- 190 vs. 149 +/- 84 mm Hg, p < 0.05). The ultrafiltration of blood priming before CPB attenuated activation of the coagulation pathway and inflammatory responses and preserved cardiopulmonary function in neonatal piglets.
Priming (agriculture)
Ultrafiltration (renal)
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Objective To investigate the protective effect of partial liquid ventilation(PLV) with perfluorocarbon(PFC) against lung injury after cardiopulmonary bypass(CPB) and the related mechanism in an animal model.Methods Twenty piglets were randomly divided into two groups: CPB group(control group,n=10) and CPB+PLV group(experimental group,n=10).Animals in the control group only received CPB,and those in the experimental group received PFC(12 mL/kg) into the trachea immediately after CPB.The two groups were given mechanical ventilation with same parameters.The gas exchange in arterial blood samples and serum tumor necrosis factors-α(TNF-α),interlukin-8(IL-8) and IL-6 were mearsured at pre-CPB,0 h,1 h and 2 h after CPB.Lung specimens were taken from left lower lung at the end of CPB so as to to observe the expression of adhesion factor Inter-cellular adhesion molecule 1(ICAM-1) and histological changes.Results Compared with control group,the experimental group had significantly lower levels of TNF-α,IL-8 and IL-6 2 h after CPB(P0.05).Compared with control group,animals in the experimental group had significantly higher arterial partial pressure of oxygen(paO2) level(P0.05) and lower arterial partial pressure of carbon dioxide(paCO2) level 1 h and 2 h after CPB(P0.05).Histologic findings showed slighter lung injury in the experimental group than in the control group.After CPB,expression of ICAM-1 was strong in the control group and weak in the experimental group.Conclusion PLV can protect lung after CPB,which might be related to improvement of paO2 and inhibition of TNF-α.
Arterial blood
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Objective To investigate the changes of cytokines during perioperation of cardiopulmonary bypass(CPB) in infants with congenital heart disease(CHD) and effect of fructose 1,6-diphosphate(FDP)on the cytokines expression.Methods Sixty-three infants with CHD who were hospitalized in Heart Center of Children′s Hospital of Jiangxi Province were selected and they were randomly divided into treatment group(n=30) and control group(n=33),FDP(200 mg·kg-1)was added into the prime fluid before CPB in treatment group but FDP was not added in control group.Blood samples were drawn at 3 time points: before CPB,3 h after CPB and 48 h after CPB.The concentration of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and IL-8 in plasma were measured by enzyme-linked immunosorbent assay.Results The concentration of TNF-α,IL-6 and IL-8 between the 2 groups showed no significant difference before CPB and 48 h after CPB(Pa0.05),but they had significant differences between both groups at 3 h after CPB(Pa0.05).At 3 h after CPB and 48 h after CPB,the concertration of TNF-α,IL-6 and IL-8 in both groups were higher than those before CPB.Conclusions The concentration of cytokines are significantly elevated after CPB which is the important factor resulting in systemic inflammatory response.FDP can reduce the concentration of TNF-α,IL-6 and IL-8 in plasma after CPB.FDP may alleviate the systemic inflammatory at after CPB and 48 h after CPB.
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OBJECTIVE To evaluate the lung protective effect of infants by the removal of allogeneic leukocytes in priming fluid on cardiopulmonary bypass(CPB)in infants.METHODSTotal 60 patients under 1 year-old with ventricular septal defect(VSD)repair undergoing CPB were randomly divided into experimental group and control group.The experimental group used leukocyte-removed priming fluid,and the control group used packed whole blood priming solution.The plasma levels of neutrophil elastase(NE),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),interleukin-8(IL-8),oxygen index(OI),alveolar-arterial oxygen difference(P(A-a)O2),respiratory index(RI)of perioperation and mechanical ventilation supporting time postoperation were measured.RESULTSPost-operative mechanical ventilation supporting time,the level of NE,TNF-α,IL-6,IL-8,P(A-a)O2,RI were lower in experimental group than those in control group(P0.05,P0.01);and OI was higher in experimental group(P0.05).CONCLUSIONUsing leukocyte-removed priming fluid could reduce the releasel of NE,TNF-α,IL-6 and IL-8,improve pulmonary oxygenation function,and is helpful for post-opertive lung protection in infants.
Oxygenation index
Priming (agriculture)
Neutrophil elastase
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Cardiac surgery in patients undergoing cardiopulmonary bypass (CPB) provokes a vigorous inflammatory response with substantial clinical implications. Once the inflammatory response is triggered by CPB, leukocytes and platelets are activated by multiple stimuli. The administration of a urinary trypsin inhibitor (ulinastatin) during CPB is hypothesized to reduce cytokine release and platelet activation and to decrease pulmonary injury. We performed a prospective randomized study to investigate the influence of high-dose ulinastatin on cytokines and platelet activation and on respiratory function during and after CPB.In this pilot, prospective, randomized and double-blinded study, 30 first-time three-vessel coronary artery disease (CAD) patients undergoing coronary artery bypass graft (CABG) were randomly divided into 2 groups: U group (n=15) received a total dose of 1000000 U ulinastatin and C group (n=15) received placebo. Blood samples were withdrawn from the central vein to measure polymorphonuclear neutrophil elastase (PMNE), tumour necrosis factor-alpha (TNF-a), interleukin-6 (IL-6) and interleukin-8 (IL-8), before induction, 30 min following clamping (T2), reperfusion 3 h (T3), reperfusion 6 h (T4) and reperfusion 12 h (T5). Whole blood samples were taken for CD62P immediately before induction (as baseline), at the end of CPB (before protamine administration), 1 h after heparin neutralization by protamine and 24 h after the operation. In addition, alveolo-arterial oxygen difference (A-aDO(2)) in pulmonary gas exchange function was calculated by obtaining arterial blood gas samples before and after CPB.There were no differences in preoperative parameters between the groups. After CPB, the levels of PMNE, TNF-alfa, IL-6 and IL-8 increased in both groups over baseline values (P<0.01). The levels of PMNE, TNF-alfa, IL-6 and IL-8 in U group were significantly lower than those in C group (P<0.05). No significant differences in CD62p expression between the 2 groups during CPB were found. A-aDO(2) in U group significantly decreased compared with C group (P<0.05) and the duration of mechanical ventilation was shorter than C group (P<0.05).Results suggest that ulinastatin may inhibit proinflammatory cytokine (PMNE, TNF-alfa, IL-6 and IL-8) release, reduce reperfusion lung injury and preserve pulmonary function but it fails to inhibit platelet activation and to prevent blood loss during CPB.
Ulinastatin
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OBJECTIVE To evalute the effect of ulinastatin on the changes of inflammatory cytokines and inflammatory response resulting from cardiopulmonary bypass(CPB)in cardiac valve replacement surgery.METHODS Thirty-six patients scheduled for elective cardiac valve replacement with CPB were randomly divided into two groups of 18 each:control group(C)and ulinastatin group(U).Group U received ulinastatin 1.2×104 U/kg and group C received same volume of normal saline instead of ulinastatin as control.Blood samples were taken from radial artery for determination of plasma TNF-α,IL-6 and IL-10 concentrations before induction of anesthesia(T1),1 h after start of CPB(T2),1 h after(T3)and 24 h(T4)after termination of CPB.All of these was estimated by enzyme-linked immunosorbent assay(ELISA).RESULTS There was no signif icant difference between two groups in plasma TNF-α,IL-6 and IL-10 level at T1.The level of TNF-α,IL-6 and IL-10 was significantly increased at T2-T4 compared with that before CPB(T1)in both groups.However,the plasma concentrations of TNF-αand IL-6 were significantly lower while the level of IL-10 was significantly higher in group U than those in group C at T2-T4.CONCLUSION Ulinastatin could reduce the increased amplitude of plasma levels of TNF-αand IL-6,whereas enhance the increased amplitude of the plasma IL-10 levels that result from CPB in cardiac valve replacement.In other word,Ulinastatin posseses the effect to regulate inflammatory cytokines balance and down-regulate inflammatory response during CPB.
Ulinastatin
Inflammatory response
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Objective
To evaluate the effects of processing banked suspended red blood cells (RBCs) with cell saver before priming on perioperative systemic inflammatory responses of infants undergoing cardiac surgery under cardiopulmonary bypass (CPB).
Methods
Forty pediatric patients of both sexes, aged 3 months-2 yr, weighing 5-13 kg, of American Society of Anesthesiologists physical status Ⅱ-Ⅳ, undergoing repair of atrial or ventricular septal defect under CPB, were divided into control group (group C, n=20) and processing group (group P, n=20) using a random number table.Banked suspended RBCs were primed directly after being added to CPB circuit in group C. Banked suspended RBCs were washed with cell saver and then primed after being added to CPB circuit in group P. At 5 min before skin incision, at 30 min after the start of CPB, at 10 min after aortic unclamping, immediately after the end of CPB and at 6, 12 and 24 h after the end of CPB (T1-7), blood samples were collected from the radial artery for determination of the concentrations of tumor necrosis factor, interleukin-1β (IL-1β), IL-6, IL-8, IL-10 and neutrophil elastase in plasma by enzyme-linked immunosorbent assay.Blood samples were taken from the radial artery at T1 and T4-7 for measurement of blood routine and plasma acute phase reactive protein concentrations.
Results
Compared with group C, the concentrations of tumor necrosis factor, IL-1β, IL-6, IL-8 and neutrophil elastase in plasma were significantly decreased at T6, 7, the total number of white blood cells, neutrophil count and concentration of plasma acute phase reactive protein were decreased at T7, and duration of stay in intensive care unit was shortened in group P (P<0.05).
Conclusion
Processing banked suspended RBCs with cell saver before priming can reduce perioperative systemic inflammatory responses of infants undergoing cardiac surgery under CPB.
Key words:
Erythrocytes; Cardiopulmonary bypass; Inflammation; Infant
Neutrophil elastase
Priming (agriculture)
White blood cell
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Objective:To determine the protective effect of cardio-pulmonary bypass(CPB) with autologous lung as oxygenator on CPB-relative inflammatory response.Methods:Twelve adult mongrel dogs were randomly divided into control group and study group.Cardiopulmonary bypass(CPB) using a membrane oxygenator(control group) or using the autologous lung(study group) for gas exchange was performed for 120 min in an alternating series of 12 mongrel dogs with the heart arrested for 90 min by crystalloid cardioplegia and 30 min reperfusion.The blood samples were collected at the same time point of pre-operation(T1),60 min of cardiopulmonary bypass(T2),and 1 hour(T3),2 hours(T4) after cardiopulmonary bypass.Plasma concentration of IL-6,IL-10,TNF-α were detected with ELISA.Results:The plasma levels of IL-6,IL-8,IL-10,TNF-α in each group were significantly increased at T2,T3,T4.The plasma levels of IL-6,IL-8 and TNF-α in study group were significantly lower than in the control group at T2,T3,T4.The plasma levels of IL-10 in study group were significantly higher than the levels in control group at T2,T3,T4.Conclusion:This study indicates that extracorporeal circulation with autologous lung as oxygenator could reduce the increased amplitude of plasma levels of TNF-α,IL-6 and IL-8 whereas enhance the increased amplitude of the plasma IL-10 levels that result from CPB.In other word,extracorporeal circulation with autologous lung as oxygenator possesses the effect to regulate inflammatory cytokine balance and down-regulate CPB-relative inflammatory response.
Oxygenator
Extracorporeal circulation
Extracorporeal
Membrane oxygenator
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Objective To investigate the effects of ulinastatin on the systemic inflammatory response in the patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB). Methods Forty ASA Ⅱ or Ⅲ patients of both sexes, aged 27-44 yr, weighing 39-72 kg, scheduled for cardiac vavle replacement, were randomly divided into 2 groups (n = 20 each) : control group (group C) and ulinastatin group (group U). Ulinastatin 10 000 U/kg was injected iv 10 min before CPB, and ulinastatin 10 000 U/kg was added to the priming fluid in group U. The equal volume of normal saline was given in stead of ulinastatin in group C. Venous blood samples were taken at 15 min before CPB (T1), 10 min of CPB (T2), and 30 and 60 min after termination of CPB (T3,4)for determination of the plasma concentrations of IL-6, IL-8, IL-10 and TNF-α. Results The plasma concentrations of IL-6, IL-8 and TNF-α were significantly lower and plasma IL-10 concentration was significantly higher during and after CPB in group U than in group C (P <0.05 or 0.01). The plasma concentrations of IL-6,IL-8, IL-10 and TNF-α were significantly higher in beth groups at T2,3 than at T, (P < 0.01). Conclusion Ulinastatin can ameliorate the unbalance between pro- and anti-inflammatory responses during CPB and reduce the systemic inflammatory response in the patients undergoing cardiac valve replacement.
Key words:
Trypsin inhibitors; Systemic inflammatory response syndrome; Cardiopulmonary bypass; Heart valve prosthesis implantation
Ulinastatin
Inflammatory response
Venous blood
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