title: Immune Dysfunction After Cardiac Surgery with Cardiopulmonary Bypass: Beneficial Effects of Maintaining Mechanical Ventilation.
abstract: Cardiac surgery with cardiopulmonary bypass (CPB) induces postoperative immunosuppression and impaired pulmonary function. Maintaining mechanical ventilation (MV) during CPB improves pulmonary function and diminishes postoperative systemic inflammation. However, there are no data about the influence of maintaining MV during CPB on postoperative immune dysfunction.
  
  
  METHODS
  Fifty patients were prospectively divided into two groups: without MV during bypass (n = 25) and dead space MV with positive end-expiratory pressure (n = 25). PaO2 (arterial oxygen tension)/FIO2 (inspired oxygen fraction) ratio, CXCL10 (C-X-C motif chemokine 10), CCL2 (chemokine ligand 2), tumor necrosis factor α (TNF-α), interleukin 10 (IL-10), human leukocyte antigen-DR antigen (HLA-DR), monocytic myeloid-derived suppressor cells (Mo-MDSCs, CD14HLA-DR monocytes), and blood cell count were collected before and after surgery.
  
  
  RESULTS
  Cardiopulmonary bypass induced a marked immunosuppression with a significant increase in plasmatic levels of TNF-α and IL-10 and a significant decrease in HLA-DR monocytic expression. The postoperative proportion of Mo-MDSCs was subsequently significantly increased. Maintaining MV during CPB significantly improved PaO2/FIO2 ratio and decreased postoperative plasmatic levels of TNF-α and IL-10 compared with patients without MV during CPB. Furthermore, nonventilated patients had a lower lymphocyte count after surgery compared with patients with MV during CPB.
  
  
  CONCLUSIONS
  Our study suggests that maintaining MV during CPB for cardiac surgery decreases postoperative immune dysfunction and could be an interesting strategy to diminish the occurrence of postoperative nosocomial infection without hampering the surgical procedure. However, these findings have to be confirmed in a clinical trial using the incidence of nosocomial infection as an endpoint.
authors.affiliation: *CHU Rennes, Anesthésie-Réanimation; †CHU Rennes, Maladies Infectieuses et Réanimation Médicale; and ‡Inserm, CIC-1414; §Biosit; and ∥Inserm, U917, Faculté de Médecine, Université Rennes I; and ¶CHU Rennes, Chirurgie Cardio-thoracique et Vasculaire, Rennes, France.
authors.forename: Baptiste
authors.initials: B
authors.lastname: Gaudriot
authors.forename: Fabrice
authors.initials: F
authors.lastname: Uhel
authors.forename: Murielle
authors.initials: M
authors.lastname: Gregoire
authors.forename: Arnaud
authors.initials: A
authors.lastname: Gacouin
authors.forename: Sebastien
authors.initials: S
authors.lastname: Biedermann
authors.forename: Antoine
authors.initials: A
authors.lastname: Roisne
authors.forename: Erwan
authors.initials: E
authors.lastname: Flecher
authors.forename: Yves
authors.initials: Y
authors.lastname: Le Tulzo
authors.forename: Karin
authors.initials: K
authors.lastname: Tarte
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Tadié
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001772:Blood Cell Count; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D003428:Cross Infection / Q000276:immunology / Q000517:prevention & control; D016207:Cytokines / Q000097:blood; D006684:HLA-DR Antigens / Q000378:metabolism; D006801:Humans; D007108:Immune Tolerance; D016867:Immunocompromised Host; D007153:Immunologic Deficiency Syndromes / Q000209:etiology* / Q000276:immunology; D007430:Intraoperative Care / Q000379:methods; D009894:Opportunistic Infections / Q000276:immunology / Q000517:prevention & control; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D011175:Positive-Pressure Respiration / Q000379:methods*; D011446:Prospective Studies
chemical_list: D016207:Cytokines; D006684:HLA-DR Antigens; D010100:Oxygen