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Influence of combined zero-balanced and modified ultrafiltration on the systemic inflammatory response during
P Tassani1, J A Richter, G P Eising
1Institute of Anesthesiology, Department of Cardiac Surgery, German Heart Center Munich at the Technical University, München.
Insights
Combined zero-balanced and modified ultrafiltration temporarily reduced inflammatory markers in coronary artery bypass graft patients. This intervention also slightly improved clinical outcomes, including shorter extubation times.
Area of Science:
- Cardiovascular Surgery
- Critical Care Medicine
- Inflammation Biology
Background:
- Coronary artery bypass graft (CABG) surgery often triggers a systemic inflammatory response.
- Cardiopulmonary bypass (CPB) is a key factor contributing to this inflammatory cascade.
- Managing the inflammatory response is crucial for improving patient outcomes after CABG.
Purpose of the Study:
- To investigate the effect of combined zero-balanced ultrafiltration and modified ultrafiltration on the systemic inflammatory response in CABG patients.
- To assess whether these ultrafiltration techniques can mitigate the release of pro-inflammatory cytokines post-CPB.
Main Methods:
- A randomized controlled trial was conducted with 43 patients undergoing elective CABG.
- The intervention group (n=21) received zero-balanced ultrafiltration during rewarming and modified ultrafiltration post-CPB.
- The control group (n=22) underwent the same procedure without ultrafiltration.
Main Results:
- Interleukin-6 and interleukin-8 levels were significantly lower immediately after CPB and ultrafiltration in the intervention group (p < 0.05).
- Intrapulmonary shunt fraction decreased, and mean arterial pressure increased during modified ultrafiltration in the intervention group (p < 0.01).
- Time to extubation was significantly shorter in the ultrafiltration group (6.1 hours) compared to the control group (8.6 hours) (p < 0.05).
Conclusions:
- Combined ultrafiltration techniques temporarily diminished the inflammatory response immediately following CPB in CABG patients.
- The observed reduction in inflammation likely contributed to slight improvements in clinical parameters, such as reduced intrapulmonary shunting and faster extubation.
- Ultrafiltration may offer a beneficial adjunct for managing the inflammatory response in the early post-operative period after CABG.
Objective:
To evaluate whether combined zero-balanced and modified ultrafiltration affects the systemic inflammatory response in coronary artery bypass graft (CABG) patients.
Design:
Randomized and controlled.
Setting:
University-affiliated heart center.
Participants:
Forty-three patients scheduled for elective CABG.
Interventions:
In the ultrafiltration group (UF group; n = 21), zero-balanced ultrafiltration was performed during rewarming and modified ultrafiltration immediately after the end of cardiopulmonary bypass (CPB). A control group of patients (n = 22) was treated identically to the treatment group except no ultrafiltration process was performed.
Measurements And Main Results:
Immediately after CPB (ie, after zero-balanced ultrafiltration), and again after the modified ultrafiltration, the concentrations of interleukin-6 and interleukin-8 were significantly less (p < 0.05) in the UF group compared with the control group. Both proinflammatory cytokine levels peaked at 2 and 4 hours after CPB, at which time no difference between the two groups could be observed. The levels of measured anti-inflammatory mediators (interleukin-10 and interleukin-1 receptor antagonist) did not show any difference between the two groups. Intrapulmonary shunt fraction decreased in the course of the modified ultrafiltration from 31% +/- 1.2% to 25% +/- 1.3% (p < 0.01), whereas mean arterial pressure increased (69 +/- 1.8 to 80 +/- 2.8 mmHg; p < 0.01); neither parameter changed in the control group. Time to extubation was shorter in the UF group (6.1 +/- 0.5 v 8.6 +/- 0.7 hours; p < 0.05).
Conclusion:
It was concluded that the use of ultrafiltration diminished inflammatory response in a very limited time period immediately after CPB and, probably as a consequence, slightly improved clinical parameters.