Intracellular adhesion molecule-1 in patients developing pulmonary insufficiency after cardiopulmonary bypass.
OBJECTIVE
Cardiopulmonary bypass activates adhesion molecules, which are associated with systemic inflammation and organ dysfunction. The intracellular adhesion molecule-1 (ICAM-1) has been evaluated in patients presenting pulmonary dysfunction after cardiac surgery.


METHODS
Postoperative serum levels of the ICAM-1 were measured in 40 patients who underwent isolated coronary artery bypass grafting, in 28 with uneventful postoperative recovery (70 %) (Group 1), and in 12 (30 %) with postoperative respiratory insufficiency (Group 2), defined by the need for prolonged (> 24 hours) mechanical ventilation using a fractional oxygen concentration of > 40 %.


RESULTS
Patients in group 1 were ventilated for 12.21 +/- 4.86 hours and those in group 2 for 92.91 +/- 48.14 hours (p < 0.001). ICAM-1 decreased from 145.98 +/- 73.40 ng/ml to 81.15 +/- 114.82 ng/ml in group 1, while in group 2 ICAM-1 showed a significant higher level and increased to 435.01 +/- 130.02 ng/ml (p < 0.001). The leukocyte count increased in both groups as well as the C-reactive protein (CRP) during the postoperative course. The CRP behaves similar in both groups (p = 0.636) in contrast to the leukocyte count which was significantly higher in group 2 (p < 0.01). While none of the patients in group 1 died the mortality in group 2 was 50 % (p < 0.001).


CONCLUSIONS
Respiratory insufficiency after cardiopulmonary bypass is associated with a distinct increase in the ICAM-1. The reason for the increase of the ICAM-1 in this small subset of patients has not been clarified.
Görlach
G
G
Department of Cardiovascular Surgery, University Hospital, Giessen, Germany. Gerold.Goerlach@chiru.med.uni-giessen.de
Sroka
J
J
Heidt
M
M
Knez
I
I
Sablotzki
A
A
Schönburg
M
M
Akintürk
H
H
Roth
P
P
Wozniak
G
G
Vogt
P R
PR
D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis; D002315:Cardiopulmonary Bypass; D016022:Case-Control Studies; D001026:Coronary Artery Bypass; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood*; D007958:Leukocyte Count; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood*; D012131:Respiratory Insufficiency / Q000097:blood* / Q000209:etiology
D018799:Intercellular Adhesion Molecule-1; D002097:C-Reactive Protein