title: Endotoxin release in cardiac surgery with cardiopulmonary bypass: pathophysiology and possible therapeutic strategies. An update.
abstract: Cardiac surgery with cardiopulmonary bypass provokes a systemic inflammatory response syndrome caused by the surgical trauma itself, blood contact with the non-physiological surfaces of the extracorporeal circuit, endotoxemia, and ischemia. The role of endotoxin in the inflammatory response syndrome has been well investigated. In this report, we reviewed recent advances in the understanding of the pathophysiology of the endotoxin release during cardiopulmonary bypass and the possible therapeutic strategies aimed to reduce the endotoxin release or to counteract the inflammatory effects of endotoxin. Although many different strategies to detoxify endotoxins were evaluated, none of them were able to show statistically significant differences in clinical outcome.
authors.affiliation: Department of Cardio-Thoracic Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5602 ZA Eindhoven, The Netherlands. skats@chello.nl
authors.forename: Suzanne
authors.initials: S
authors.lastname: Kats
authors.forename: Jacques P A M
authors.initials: JP
authors.lastname: Schönberger
authors.forename: Ruud
authors.initials: R
authors.lastname: Brands
authors.forename: Willem
authors.initials: W
authors.lastname: Seinen
authors.forename: Wim
authors.initials: W
authors.lastname: van Oeveren
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000469:Alkaline Phosphatase / Q000502:physiology; D000890:Anti-Infective Agents / Q000627:therapeutic use; D000906:Antibodies / Q000502:physiology; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D016207:Cytokines / Q000502:physiology; D004187:Disaccharides / Q000627:therapeutic use; D004731:Endotoxins / Q000276:immunology / Q000378:metabolism*; D006464:Hemoperfusion / Q000379:methods; D006801:Humans; D007036:Hypothermia, Induced; D007650:Ketanserin / Q000627:therapeutic use; D012702:Serotonin Antagonists / Q000627:therapeutic use; D013403:Sugar Phosphates / Q000627:therapeutic use; D018746:Systemic Inflammatory Response Syndrome / Q000188:drug therapy / Q000209:etiology* / Q000378:metabolism; D013654:Taurine / Q000031:analogs & derivatives / Q000627:therapeutic use; D013829:Thiadiazines / Q000627:therapeutic use; D051197:Toll-Like Receptor 4 / Q000037:antagonists & inhibitors
chemical_list: D000305:Adrenal Cortex Hormones; D000890:Anti-Infective Agents; D000906:Antibodies; D016207:Cytokines; D004187:Disaccharides; D004731:Endotoxins; D012702:Serotonin Antagonists; D013403:Sugar Phosphates; D013829:Thiadiazines; D051197:Toll-Like Receptor 4; D013654:Taurine; C512420:eritoran; C012566:taurolidine; D007650:Ketanserin; D000469:Alkaline Phosphatase