title: Inflammatory response and extracorporeal circulation.
abstract: Patients undergoing cardiac surgery with extracorporeal circulation (EC) frequently develop a systemic inflammatory response syndrome. Surgical trauma, ischaemia-reperfusion injury, endotoxaemia and blood contact to nonendothelial circuit compounds promote the activation of coagulation pathways, complement factors and a cellular immune response. This review discusses the multiple pathways leading to endothelial cell activation, neutrophil recruitment and production of reactive oxygen species and nitric oxide. All these factors may induce cellular damage and subsequent organ injury. Multiple organ dysfunction after cardiac surgery with EC is associated with an increased morbidity and mortality. In addition to the pathogenesis of organ dysfunction after EC, this review deals with different therapeutic interventions aiming to alleviate the inflammatory response and consequently multiple organ dysfunction after cardiac surgery.
authors.affiliation: Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Münster, Germany. Electronic address: kraftf@uni-muenster.de.
authors.forename: Florian
authors.initials: F
authors.lastname: Kraft
authors.affiliation: Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Münster, Germany. Electronic address: schmch@uni-muenster.de.
authors.forename: Christoph
authors.initials: C
authors.lastname: Schmidt
authors.affiliation: Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Münster, Germany. Electronic address: hva@uni-muenster.de.
authors.forename: Hugo
authors.initials: H
authors.lastname: Van Aken
authors.affiliation: Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Münster, Germany. Electronic address: zarbock@uni-muenster.de.
authors.forename: Alexander
authors.initials: A
authors.lastname: Zarbock
mesh_terms: D000818:Animals; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000639:trends; D005112:Extracorporeal Circulation / Q000009:adverse effects* / Q000639:trends; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage; D007249:Inflammation / Q000209:etiology / Q000378:metabolism / Q000517:prevention & control; D018836:Inflammation Mediators / Q000037:antagonists & inhibitors* / Q000378:metabolism; D011183:Postoperative Complications / Q000209:etiology* / Q000378:metabolism / Q000517:prevention & control; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology* / Q000378:metabolism / Q000517:prevention & control
chemical_list: D005938:Glucocorticoids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D018836:Inflammation Mediators
keywords: extracorporeal circulation; inflammation; neutrophil recruitment; systemic inflammatory response syndrome