The use of ultrafiltration for inflammatory mediators removal during cardiopulmonary bypass in coronary artery bypass graf surgery.
OBJECTIVE
To investigate the effectiveness of ultrafiltration in removing inflammatory mediators released by cardiopulmonary bypass and to correlate ultrafiltration with alterations in organic function according to the Sequential Organ Failure Assessment Score.


METHODS
Forty patients were included and randomized into two groups: "no ultrafiltration" (n=20; Group I) and "ultrafiltration" (n=20; Group II). Activated complement 3 and 4, interleukins 1beta, 6, 8 and tumor necrosis factor alfa were measured prior to anesthesia induction (Time 1), 5 minutes before cardiopulmonary bypass (Time 2), in the ultrafiltrated fluid (Time 3), 30 minutes (Time 4), and 6 (Time 5), 12 (Time 6), 24 (Time 7), 36 (Time 8) and 48 (Time 9) hours following cardiopulmonary bypass. Sequential Organ Failure Assessment Score was evaluated at Time 1, 6 and 9. Statistical significance was established at p < 0.05.


RESULTS
In the ultrafiltrated fluid, only tumor necrosis factor alfa levels were detected. Levels of activated complement 3 at Times 5 and 7 and activated complement 4 at Times 5 and 6 were significantly higher in the unfiltered Group, and levels of interleukin 6 were higher in the filtered Group at Times 7 and 8. Interleukins 1beta, 8, tumor necrosis factor alfa, and the Sequential Organ Failure Assessment score were not significantly different between the groups.


CONCLUSIONS
Ultrafiltration significantly filtered tumor necrosis factor alfa but did not influences serum levels of this cytokine. Ultrafiltration with the type of filter used in this study had no effect in organic dysfunction and should be used only for volemic control in patients undergo cardiopulmonary bypass.
Antunes
Nilson
N
Cardiac Surgery Unit, Department of Surgery, School of Medical Sciences, State University of Campinas (UNICAMP), SP, Brasil. cirurgia@fcm.unicamp.br
Dragosavc
Desanka
D
Petrucci Junior
Orlando
O
Oliveira
Pedro Paulo Martins de
PP
Kosour
Carolina
C
Blotta
Maria Heloisa Souza Lima
MH
Braile
Domingo Marcolino
DM
Vieira
Reinaldo Wilson
RW
D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D016009:Chi-Square Distribution; D015926:Complement C3a / Q000032:analysis; D015934:Complement C4a / Q000032:analysis; D001026:Coronary Artery Bypass; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006440:Hemofiltration / Q000592:standards*; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D053583:Interleukin-1beta / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000175:diagnosis*; D011446:Prospective Studies; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
D018836:Inflammation Mediators; D053583:Interleukin-1beta; D015850:Interleukin-6; D016209:Interleukin-8; D014409:Tumor Necrosis Factor-alpha; D015926:Complement C3a; D015934:Complement C4a