Endotoxin release in cardiac surgery with cardiopulmonary bypass: pathophysiology and possible therapeutic strategies. An update.
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.
Kats
Suzanne
S
Department of Cardio-Thoracic Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5602 ZA Eindhoven, The Netherlands. skats@chello.nl
Schönberger
Jacques P A M
JP
Brands
Ruud
R
Seinen
Willem
W
van Oeveren
Wim
W
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
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