Document Detail


Effects of normothermia versus hypothermia on extravascular lung water and serum cytokines during cardiopulmonary bypass: a randomized, controlled trial.
MedLine Citation:
PMID:  11588449     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To evaluate the influence of perfusion temperature on the systemic effects of cardiopulmonary bypass (CPB), including extravascular lung water index (EVLWI), and serum cytokines. DESIGN: Prospective, randomized, controlled study. SETTING: Cardiothoracic intensive care unit of a university hospital. PATIENTS: Patients undergoing elective coronary artery bypass grafting. INTERVENTIONS: Twenty-one patients undergoing elective coronary artery bypass grafting were randomly assigned to receive either normothermic bypass (36 degrees C, n = 8) with intermittent antegrade warm blood cardioplegia (IAWBC), or hypothermic (32 degrees C, n = 13) CPB with cold crystalloid cardioplegia. MEASUREMENTS AND MAIN RESULTS: Mean arterial pressure, heart rate, cardiac output, systemic vascular resistance, mean pulmonary arterial pressure, and pulmonary vascular resistance were determined at baseline, i.e., after induction of anesthesia but before sternal opening (T-1), at arrival in the intensive care unit (T0), and 4 hrs (T4), 8 hrs (T8), and 24 hrs (T24) after surgery. EVLWI, intrathoracic blood volume index (ITBVI), and EVLW/ITBV ratio were obtained by using thermal dye dilution utilizing an arterial thermistor-tipped fiberoptic catheter and were recorded at T-1, T0, T4, T8, and T24. Serial blood samples for cytokine measurements were obtained at each hemodynamic measurement time point. Before, during, and after CPB, there were no differences in the conventional hemodynamic measurements between the groups. There were no changes in EVLWI up to T8 in either group. Furthermore, no change in the ratio EVLW/ITBW was observed between the groups at any time, further indicating the absence of a change in pulmonary permeability. Plasma levels of interleukin-6, tumor necrosis factor-alpha, and interleukin-10 increased during and after CPB, independently of the perfusion temperature. CONCLUSION: Normothermic CPB is not associated with additional inflammatory and related systemic adverse effects regarding cytokine production and EVLWI as compared with mild hypothermia. The potential temperature-dependent release of cytokines and subsequent inflammation has not been observed and normothermic CPB may be seen as a safe technique regarding this issue.
Authors:
P M Honore; L M Jacquet; R J Beale; J C Renauld; D Valadi; P Noirhomme; M Goenen
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Critical care medicine     Volume:  29     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2001 Oct 
Date Detail:
Created Date:  2001-10-05     Completed Date:  2001-11-01     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1903-9     Citation Subset:  AIM; IM    
Affiliation:
Cardiothoracic Intensive Care Unit, St-Luc Teaching Hospital, Brussels, Belgium. Pathonor@skynet.be
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MeSH Terms
Descriptor/Qualifier:
Adult
Body Water
Cardioplegic Solutions / pharmacology*
Cardiopulmonary Bypass / adverse effects,  methods*
Coronary Care Units
Cytokines / metabolism*
Female
Follow-Up Studies
Hemodynamics / physiology
Humans
Hypothermia, Induced
Inflammation Mediators / analysis*
Lung
Male
Middle Aged
Multivariate Analysis
Probability
Prospective Studies
Surgical Procedures, Elective
Temperature*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Cardioplegic Solutions; 0/Cytokines; 0/Inflammation Mediators

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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