title: Key Points for Curbing Cardiopulmonary Bypass Inflammation.
abstract: OBJECTIVE
  Cardiopulmonary bypass (CPB) procedures are thought to activate systemic inflammatory reaction syndrome (SIRS). Strategies to curb systemic inflammation have been previously described. However, none of them is adequate, since "curbing" the extent of the inflammatory response requires a multimodal approach. The aim of the present mini-review is to discuss the main key points about the main principles in cardiopulmonary bypass curbing inflammation.
  
  
  METHODS
  No systematic literature search (MEDLINE) and extracted data from the accumulated experience of the authors. The preconceived idea of an association between severe inflammation and coagulation disorders is reviewed. Also, some fundamental concepts, CPB inflammatory biomarkers, the vasoplegic syndrome and the need forindividual CPB protocols for children, diabetes and old patients, are discussed.
  
  
  CONCLUSIONS
  The ways in which surgical technique (atraumatic vein harvest, biocompatibility and shear resistance of the circuit, monitoring, minimizing organ ischemia, minimal cross-clamping trauma, and blood management) are thought to curb SIRS induced by CPB and affect positively the patient outcome.Improved patient outcomes are strongly associated with these modalities of care, more than single or combinatorial drug strategies (aprotinin, tranexamic acid, pentoxifylline) or CPB modalities (minicircuits, heparin-coated circuits, retrograde autologous prime).
authors.affiliation: Ribeirão Preto Medical School, University of São Paulo, Brazil.
authors.forename: Paulo Roberto Barbosa
authors.initials: PR
authors.lastname: Evora
authors.affiliation: Ribeirão Preto Medical School, University of São Paulo, Brazil.
authors.forename: Camila
authors.initials: C
authors.lastname: Bottura
authors.affiliation: Ribeirão Preto Medical School, University of São Paulo, Brazil.
authors.forename: Livia
authors.initials: L
authors.lastname: Arcêncio
authors.affiliation: Ribeirão Preto Medical School, University of São Paulo, Brazil.
authors.forename: Agnes Afrodite Sumarelli
authors.initials: AA
authors.lastname: Albuquerque
authors.affiliation: Veterinary School, São Paulo State University, Jaboticabal, Brazil.
authors.forename: Patrícia Martinez
authors.initials: PM
authors.lastname: Évora
authors.affiliation: Ribeirão Preto Medical School, University of São Paulo, Brazil.
authors.forename: Alfredo José
authors.initials: AJ
authors.lastname: Rodrigues
mesh_terms: D015415:Biomarkers / Q000097:blood; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D016207:Cytokines / Q000097:blood; D048909:Diabetes Complications / Q000503:physiopathology; D006801:Humans; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology* / Q000503:physiopathology; D056987:Vasoplegia / Q000209:etiology / Q000503:physiopathology
chemical_list: D015415:Biomarkers; D016207:Cytokines