title: Prolonged Cardiopulmonary Bypass is a Risk Factor for Intestinal Ischaemic Damage and Endotoxaemia.
abstract: BACKGROUND
  Intestinal ischaemia-reperfusion, a frequent occurrence during cardiac surgery with cardiopulmonary bypass (CPB) induces a systemic inflammatory reaction. We hypothesised that ischaemia-reperfusion following prolonged CPB could increase intestinal permeability and thus, lead to endotoxin translocation from the intestine to the bloodstream.
  
  
  METHODS
  Patients subjected to coronary artery bypass grafting with CPB were included: Group 1 (CPB ≥90minutes) or Group 2 (CPB <90minutes). Intestinal Fatty Acid Binding Protein (I-FABP), TNF alpha, IL6, IL8, and endotoxin levels were measured before the induction of general anaesthesia (T1), at 6 (T2), and 24hours (T3) after surgery.
  
  
  RESULTS
  The low level of I-FABP at T1 increased for every patient in Group 1 at T2 (from 1015.5pg/mL to 2608.5pg/mL, p=0.02) and in Group 2 (from 1123.5pg/ml to 2284.0pg/ml, p<0.001). Furthermore, at T3, the I-FABP level was over three times higher in Group 1 than in Group 2 (2178pg/mL vs 615pg/mL; p<0.001). I-FABP correlated with CPB time (R=0.6, p<0.001) at T3. After surgery, endotoxins were elevated in 73% of patients in Group 1 and in 32% in Group 2 and correlated with CPB time (at T2, R=0.5, p=0.002; at T3, R=0.4, p=0.016).
  
  
  CONCLUSIONS
  The duration of CPB is linked to the release of biomarkers that indicate ischaemic-reperfusion damage to the gastrointestinal mucosa and endotoxaemia. I-FABP assay may help to identify patients presenting with intestinal damage, who are at risk of bacterial translocation.
authors.affiliation: Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland'. Electronic address: barbara.adamik@umed.wroc.pl.
authors.forename: Barbara
authors.initials: B
authors.lastname: Adamik
authors.affiliation: Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland'.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Kübler
authors.affiliation: Department of Cardiac Surgery, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Gozdzik
authors.affiliation: Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland'.
authors.forename: Waldemar
authors.initials: W
authors.lastname: Gozdzik
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D016207:Cytokines / Q000097:blood*; D019446:Endotoxemia / Q000097:blood* / Q000209:etiology; D050556:Fatty Acid-Binding Proteins / Q000097:blood*; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000097:blood* / Q000209:etiology; D007413:Intestinal Mucosa / Q000293:injuries; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood*; D015427:Reperfusion Injury / Q000097:blood* / Q000209:etiology; D013997:Time Factors
chemical_list: D015415:Biomarkers; D016207:Cytokines; D050556:Fatty Acid-Binding Proteins
keywords: Cardiopulmonary bypass; Endotoxin; Intestinal fatty acid binding protein; Intestinal ischaemia-reperfusion