title: Leukocyte filtration improves pulmonary function and reduces the need for postoperative non-invasive ventilation.
abstract: OBJECTIVE
  Leukocyte depletion (LD) has been reported to reduce inflammatory damage during cardiopulmonary bypass (CPB). We evaluated the role of LD in pulmonary function and inflammatory response.
  
  
  METHODS
  Seventy consecutive CABG patients were randomized (1:1) to receive LD on both arterial and cardioplegia lines (Filters) or standard arterial filters (Controls) during CPB. Estimates of pulmonary function, inflammatory and anti-inflammatory cytokines were collected pre-, intra- and postoperatively.
  
  
  RESULTS
  Hospital mortality, intensive care and in-hospital lengths of stay were similar. Although duration of ventilation and incidence of pneumonia were comparable, leukodepleted patients showed higher PaO2/FiO2 (p-between groups = 0.005; ICU arrival p = 0.023; 24 hours p = 0.039; 48 hours p<0.001) and lower need for postoperative non-invasive ventilation (NIV), (p = 0.029). Moreover, Filters showed lower inflammatory burst at 24 hours (IL-6 p<0.001; IL-8 p = 0.002) and 48 hours (IL-6 p = 0.015). This was associated with a lower release of the anti-inflammatory IL-10 (p-between groups = 0.030; ICU admission p = 0.002; 24 hours p = 0.003). Furthermore, IL-2 concentration proved higher in Filters (p-between groups = 0.013; ICU arrival p = 0.029; 24 hours p = 0.040; 48 hours p = 0.021) in association with lower leukocyte and platelet counts at ICU admission.
  
  
  CONCLUSIONS
  LD resulted in lower inflammatory burst and less need for release of anti-inflammatory cytokines. Although hospital outcomes were similar in terms of mortality and length of stay, improvements in pulmonary function and reduced need for postoperative NIV support the use of LD.
authors.affiliation: Cardiac Surgery Unit, Ferrarotto Hospital, University of Catania, Catania, Italy. antonio.rubino@hotmail.com
authors.forename: Antonino S
authors.initials: AS
authors.lastname: Rubino
authors.forename: Giuseppe F
authors.initials: GF
authors.lastname: Serraino
authors.forename: Roberto
authors.initials: R
authors.lastname: Marsico
authors.forename: Valeria
authors.initials: V
authors.lastname: Ventura
authors.forename: Daniela
authors.initials: D
authors.lastname: Foti
authors.forename: Elio
authors.initials: E
authors.lastname: Gulletta
authors.forename: Attilio
authors.initials: A
authors.lastname: Renzulli
mesh_terms: D000328:Adult; D000368:Aged; D002315:Cardiopulmonary Bypass / Q000379:methods* / Q000401:mortality; D016207:Cytokines / Q000097:blood; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D047589:Leukocyte Reduction Procedures / Q000379:methods*; D008168:Lung / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation; D011184:Postoperative Period
chemical_list: D016207:Cytokines