title: Intraoperative cell salvage during cardiac surgery is associated with reduced postoperative lung injury.
abstract: OBJECTIVE
  In addition to its blood-sparing effects, intraoperative cell salvage may reduce lung injury following cardiac surgery by removing cytokines, neutrophilic proteases and lipids that are present in cardiotomy suction blood. To test this hypothesis, we performed serial measurements of biomarkers of the integrity of the alveolar-capillary membrane, leucocyte activation and general inflammation. We assessed lung injury clinically by the duration of postoperative mechanical ventilation and the alveolar arterial oxygen gradient.
  
  
  METHODS
  Serial measurements of systemic plasma concentrations of interleukin-6 (IL-6), myeloperoxidase, elastase, surfactant protein D (SP-D), Clara cell 16 kD protein (CC16) and soluble receptor for advanced glycation endproducts (sRAGEs) were performed on blood samples from 195 patients who underwent cardiac surgery with the use of a cell salvage (CS) device (CS, n = 99) or without (CONTROL, n = 96).
  
  
  RESULTS
  Postoperative mechanical ventilation time was shorter in the CS group than in the CONTROL group [10 (8-15) vs 12 (9-18) h, respectively, P = 0.047]. The postoperative alveolar arterial oxygen gradient, however, was not different between groups. After surgery, the lung injury biomarkers CC16 and sRAGEs were lower in the CS group than in the CONTROL group. Biomarkers of systemic inflammation (IL-6, myeloperoxidase and elastase) were also lower in the CS group. Finally, mechanical ventilation time correlated with CC16 plasma concentrations.
  
  
  CONCLUSIONS
  The intraoperative use of a cell salvage device resulted in less lung injury in patients after cardiac surgery as assessed by lower concentrations of lung injury markers and shorter mechanical ventilation times.
authors.affiliation: HaemoScan B.V., Groningen, Netherlands gerwinengels@gmail.com.
authors.forename: Gerwin E
authors.initials: GE
authors.lastname: Engels
authors.affiliation: Department of Anesthesiology, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: van Klarenbosch
authors.affiliation: Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
authors.forename: Y John
authors.initials: YJ
authors.lastname: Gu
authors.affiliation: HaemoScan B.V., Groningen, Netherlands Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
authors.forename: Willem
authors.initials: W
authors.lastname: van Oeveren
authors.affiliation: Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
authors.forename: Adrianus J
authors.initials: AJ
authors.lastname: de Vries
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D016207:Cytokines / Q000097:blood; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D008055:Lipids / Q000097:blood; D055370:Lung Injury / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D057725:Operative Blood Salvage; D011446:Prospective Studies; D037663:Pulmonary Surfactant-Associated Protein D / Q000097:blood; D000067759:Receptor for Advanced Glycation End Products / Q000097:blood; D012121:Respiration, Artificial; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014598:Uteroglobin / Q000097:blood
chemical_list: C000593871:AGER protein, human; D015415:Biomarkers; D016207:Cytokines; D018836:Inflammation Mediators; D008055:Lipids; D037663:Pulmonary Surfactant-Associated Protein D; D000067759:Receptor for Advanced Glycation End Products; C556389:SCGB1A1 protein, human; D014598:Uteroglobin
keywords: Extracorporeal circulation; Lung