title: In high-risk patients, combination of antiinflammatory procedures during cardiopulmonary bypass can reduce incidences of inflammation and oxidative stress.
abstract: Previous studies showed that cardiopulmonary bypass (CPB) was directly associated with a global activation of the inflammatory response, production of oxygen free radicals, and signs of myocardial injury. We therefore evaluated, in the weakest patients, the biological and clinical benefits of a therapeutic optimization of CPB through the combination of several antiinflammatory procedures. High-risk patients undergoing cardiac surgery under CPB were included in this prospective randomized study. Control patients (n = 14) underwent conventional CPB, and treated patients (n = 13) underwent a CPB with Baxter Duraflo II heparin-coated circuits, high doses of aprotinin, and pre-CPB hemofiltration. Usual clinical hemodynamic and biological criteria, inflammation, and oxidative stress markers were measured before, during, and to the second postoperative day. Free radicals were quantified using electronic spin resonance spectroscopy with a spin trap. Significantly lower concentrations of C-reactive protein, interleukin-6, creatine kinase-MB, I-troponin, lactic acid, and systemic free radicals were observed in the plasma of treated patients. These patients had a reduction of postoperative complications and of the length of stay in the intensive care unit. Therefore, pre-CPB therapeutic optimization can reduce the inflammatory response, lower the level of oxidative stress, and help to ameliorate clinical outcome in high-risk patients.
authors.affiliation: Anaesthesia and Intensive Care Unit, Bocage Hospital, Dijon, France.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Goudeau
authors.forename: Gaëlle
authors.initials: G
authors.lastname: Clermont
authors.forename: Olivier
authors.initials: O
authors.lastname: Guillery
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Lemaire-Ewing
authors.forename: Andy
authors.initials: A
authors.lastname: Musat
authors.forename: Magali
authors.initials: M
authors.lastname: Vernet
authors.forename: Catherine
authors.initials: C
authors.lastname: Vergely
authors.forename: Michel
authors.initials: M
authors.lastname: Guiguet
authors.forename: Luc
authors.initials: L
authors.lastname: Rochette
authors.forename: Claude
authors.initials: C
authors.lastname: Girard
mesh_terms: D000210:Acute-Phase Reaction / Q000378:metabolism / Q000517:prevention & control; D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007249:Inflammation / Q000378:metabolism / Q000517:prevention & control; D008297:Male; D018384:Oxidative Stress / Q000502:physiology; D011446:Prospective Studies; D017382:Reactive Oxygen Species / Q000378:metabolism; D012307:Risk Factors
chemical_list: D017382:Reactive Oxygen Species