A single prophylactic dose of pentoxifylline reduces high dependency unit time in cardiac surgery - a prospective randomized and controlled study.
BACKGROUND
The pathogenesis of the post cardiopulmonary bypass (CPB) organ dysfunction syndrome is complex, with inflammation being an important component. The purpose of this prospective, randomized and controlled study was to evaluate the effect of a single dose of pentoxifylline (PTX) prior to CPB on high dependency unit time.


METHODS
We studied 39 patients undergoing aorto-coronary bypass surgery with CPB. Patients received either 5 mg kg(-1) PTX after induction of anaesthesia or saline as placebo. Haemodynamics, parameters of pulmonary function and plasma levels of tumour necrosis factor alpha (TNFalpha) and C-reactive protein (CRP) were measured after the induction of anaesthesia (pre-CPB) and after weaning from CPB (post-CPB), 1 h after the admission to the intensive care unit (ICU) and on the morning of the first postoperative day (1 POD), respectively. In addition, ventilation time and the high dependency unit time, i.e. the time till transferral to a peripheral ward, were documented.


RESULTS
Patients in the PTX group had lower TNFalpha values (6.3 ng ml(-1) (4/8.2) vs 9.1 ng ml(-1) (6.5/13.7)) (median (25%/75%), p=0.021), lower systolic (28+/-7 mm Hg vs 35 +/- 9 mm Hg, mean+/-SD, p=0.011) and mean pulmonary artery pressures (21+/-5 vs 26+/-6 mm Hg, p=0.017) after admission to the ICU than control patients. Haemodynamics and pulmonary function parameters did not differ. There was a trend towards earlier weaning from the respirator in the PTX group (10.0+/-3.5 h) (min/max: 4/16; confidence interval (ConF): 1.8 h) than the control group (12.3+/-4.2 h) (min/max: 5-24; ConI: 2.4 h) (p=0.077). Patients treated with PTX could be transferred to a peripheral ward about 24 h earlier than control patients (95+/-35 h, min/max: 32/190 h; ConI: 17 h; 119+/-29 h, min/max: 66/165 h; ConI: 16 h) respectively; p=0.037).


CONCLUSIONS
A single dose of PTX prior to CPB was able to reduce plasma levels of TNFalpha. In this descriptive study, there was a trend towards reduced duration of ventilation and the high dependency unit time, i.e. the time till transferral to a peripheral ward was shortened.
Heinze
Hermann
H
Department of Anaesthesiology, University of Luebeck, Luebeck, Germany. Hermannheinze@ngi.de
Rosemann
Carmen
C
Weber
Christian
C
Heinrichs
Gerhard
G
Bahlmann
Ludger
L
Misfeld
Martin
M
Heringlake
Matthias
M
Eichler
Wolfgang
W
D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D001026:Coronary Artery Bypass; D003422:Critical Care; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010431:Pentoxifylline / Q000008:administration & dosage*; D010726:Phosphodiesterase Inhibitors / Q000008:administration & dosage*; D011182:Postoperative Care; D011446:Prospective Studies; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology / Q000517:prevention & control*; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism; D014665:Vasodilator Agents / Q000008:administration & dosage; D015300:Ventilator Weaning
D010726:Phosphodiesterase Inhibitors; D014409:Tumor Necrosis Factor-alpha; D014665:Vasodilator Agents; D002097:C-Reactive Protein; D010431:Pentoxifylline