Document Detail


Elimination of proinflammatory cytokines in pediatric cardiac surgery: analysis of ultrafiltration method and filter type.
MedLine Citation:
PMID:  15173725     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: This study was undertaken to assess whether different filter types or ultrafiltration methods influence inflammatory markers in pediatric cardiac surgery. METHODS: Forty-one children younger than 5 years were prospectively randomized to groups A (polyamid filter with conventional ultrafiltration), B (polyamid filter with modified ultrafiltration), C (polysulfon filter with conventional ultrafiltration), and D (polysulfon filter with modified ultrafiltration). Interleukin 6, interleukin 10, tumor necrosis factor, terminal complement complex, and lactoferrin were measured before the operation (T0), before rewarming (T1), after ultrafiltration (T2), at 6 (T3) and 18 hours (T4) after the operation, and in the ultrafiltrate. RESULTS: All markers changed with both ultrafiltration methods, both filter types, and in all groups (except tumor necrosis factor) along the T0 to T4 observation time (P <.0001). Their patterns of changes were different for terminal complement complex, with less decrease after use of the polysulfon filter (P <.05), and among groups A through D for interleukin 6 (P =.01), with more decrease in group C than group A (P <.02). Interleukin 10 decreased with the polyamid filter (P <.001) but not with the polysulfon filter. In the ultrafiltrate, tumor necrosis factor was higher with the polysulfon filter than the polyamid filter (6.8 +/- 5 pg/mL vs 4.0 +/- 3.7 pg/mL, P <.05). The ultrafiltrate/plasma ratio of interleukin 6 was higher with conventional ultrafiltration than modified ultrafiltration (0.018 +/- 0.017 vs 0.004 +/- 0.007, P <.005). CONCLUSIONS: The polysulfon filter showed a filtration profile for inflammatory mediators superior to that of the polyamid filter for interleukin 6, tumor necrosis factor, and interleukin 10. Interleukin 6 was most efficiently removed by conventional ultrafiltration with a polysulfon filter, and tumor necrosis factor was best removed by modified ultrafiltration with a polysulfon filter, whereas other inflammatory mediators were not influenced by filter type or ultrafiltration method. Therefore combined conventional and modified ultrafiltration with a polysulfon filter may currently be the most effective strategy for removing inflammatory mediators in pediatric heart surgery.
Authors:
Pascal A Berdat; Evelyne Eichenberger; Julia Ebell; Jean-Pierre Pfammatter; Mladen Pavlovic; Claudia Zobrist; Erich Gygax; Urs Nydegger; Thierry Carrel
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  127     ISSN:  0022-5223     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2004 Jun 
Date Detail:
Created Date:  2004-06-02     Completed Date:  2004-07-13     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1688-96     Citation Subset:  AIM; IM    
Affiliation:
Clinic for Cardiovascular Surgery, University Hospital, Bern, Switzerland. pascal.berdat@insel.ch
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MeSH Terms
Descriptor/Qualifier:
Biological Markers / analysis
Cardiac Surgical Procedures / methods
Cardiopulmonary Bypass / instrumentation*,  methods
Child, Preschool
Complement C3a / analysis
Complement Membrane Attack Complex / analysis
Cytokines / analysis,  metabolism*
Female
Heart Defects, Congenital / diagnosis,  surgery*
Hemofiltration / instrumentation*,  methods
Humans
Inflammation Mediators / analysis,  metabolism*
Interleukin-10 / analysis
Interleukin-6 / analysis
Lactoferrin / analysis
Male
Micropore Filters*
Monitoring, Physiologic
Postoperative Care
Postoperative Period
Probability
Prognosis
Prospective Studies
Sensitivity and Specificity
Statistics, Nonparametric
Tumor Necrosis Factor-alpha / analysis
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Complement Membrane Attack Complex; 0/Cytokines; 0/Inflammation Mediators; 0/Interleukin-6; 0/Lactoferrin; 0/Tumor Necrosis Factor-alpha; 130068-27-8/Interleukin-10; 80295-42-7/Complement C3a

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


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