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Multiple sequential insults cause post-pump syndrome.

A L Picone1, C J Lutz, C Finck

  • 1Department of Surgery, SUNY Health Science Center, Syracuse, New York 13210, USA.

The Annals of Thoracic Surgery
|May 13, 1999
PubMed
Summary
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Post-pump syndrome (PPS) is triggered by cardiopulmonary bypass (CPB) priming the inflammatory system. Subsequent exposure to endotoxin activates sequestered white blood cells, causing PPS, confirming multiple insults as the cause.

Area of Science:

  • Cardiovascular Surgery
  • Immunology
  • Pulmonary Medicine

Background:

  • Post-pump syndrome (PPS) following cardiopulmonary bypass (CPB) is hypothesized to result from multiple minor insults.
  • The underlying mechanism is thought to involve priming and activation of polymorphonuclear (PMN) leukocytes.

Purpose of the Study:

  • To investigate the pathophysiologic and morphometric mechanisms of PPS in a porcine model.
  • To determine if sequential insults, specifically CPB and endotoxin exposure, induce PPS.

Main Methods:

  • A porcine model was used with five groups: Control, CPB only, lipopolysaccharide (LPS) only, Heparin+protamine+LPS (HP+LPS), and CPB+LPS.
  • Hemodynamic function, respiratory parameters (PaO2, shunt fraction), and lung tissue morphometry (density, cell sequestration) were assessed.

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Main Results:

  • The CPB+LPS group exhibited acute respiratory distress characteristic of PPS, with decreased PaO2 and increased intrapulmonary shunt.
  • CPB+LPS significantly increased lung tissue density and sequestration of monocytes and PMNs compared to other groups.
  • Alveolar macrophages increased in all groups receiving LPS.

Conclusions:

  • Cardiopulmonary bypass primes the pulmonary inflammatory system, leading to PMN sequestration without immediate lung injury.
  • A low dose of endotoxin, otherwise benign, activates these sequestered PMNs, resulting in PPS.
  • This study supports the hypothesis that PPS results from the cumulative effect of multiple minor insults.