The impact of the pro- and anti-inflammatory immune response on ventilation time after cardiac surgery.
BACKGROUND
Cardiac surgery using cardiopulmonary bypass (CPB) may induce a systemic inflammatory response syndrome (SIRS), which is associated with an increased risk of postoperative morbidity and mortality. The intention of this pilot study was to investigate the influence of the pro- and anti-inflammatory cytokine responses as well as of released adhesion molecules and endotoxin on the time requirements for assisted postoperative respiration following CPB surgery.


METHODS
One hundred consecutive patients undergoing elective coronary artery bypass grafting (CABG) using CPB were prospectively investigated. Blood levels of cytokines, adhesion molecules, and endotoxins were serially measured at four time points perioperatively.


RESULTS
All patients survived the observation period. Eighty-five patients were uneventful (group 1), whereas 15 patients required prolonged ventilation (34.8 +/- 9.2 h; group 2). All patients developed a pro-inflammatory and a compensatory anti-inflammatory cytokine response. An endotoxin liberation was found in parallel. The prediction of prolonged respirator dependence may be possible at completion of surgery using a combined data pattern analysis, including interleukin (IL)-6, IL-8, IL-4, endotoxins, vascular cell adhesion molecule (VCAM)-1, age, and cross clamp (x-clamp) time. Using arbitrary cutoff points improved sensitivity (0.92), specificity (0.90), positive prediction (0.87), and negative prediction (0.85) (all P < 0.02), and the ODD ratio (2.1) was found.


CONCLUSIONS
Cardiac surgery and CPB induces both a pro- and anti-inflammatory immune response. The use of a data pattern instead of several individual parameters seems advantageous for individualized predictions on postoperative recovery in CPB surgery.
Rothenburger
Markus
M
Department of Thoracic and Cardiovascular Surgery, University of Muenster, Muenster, Germany. markus.rothenburger@thgms.uni-muenster.de
Tjan
Tonny D T
TD
Schneider
Michael
M
Berendes
Elmar
E
Schmid
Christof
C
Wilhelm
Markus J
MJ
Böcker
Dirk
D
Scheld
Hans Heinrich
HH
Soeparwata
Rasjid
R
D000368:Aged; D002315:Cardiopulmonary Bypass; D004731:Endotoxins / Q000097:blood; D005260:Female; D006801:Humans; D007107:Immune System / Q000502:physiology*; D007239:Infections / Q000175:diagnosis* / Q000276:immunology*; D015847:Interleukin-4 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000276:immunology; D011237:Predictive Value of Tests; D012372:ROC Curve; D012121:Respiration, Artificial; D019010:Vascular Cell Adhesion Molecule-1 / Q000097:blood
D004731:Endotoxins; D015850:Interleukin-6; D016209:Interleukin-8; D019010:Vascular Cell Adhesion Molecule-1; D015847:Interleukin-4