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Cardiopulmonary bypass reduces pulmonary surfactant activity in infants
M Griese1, C Wilnhammer, S Jansen
1Ludwig-Maximilians-University, Munich, Germany.
Insights
Infants undergoing cardiopulmonary bypass surgery experience lung injury due to surfactant system impairment. Post-surgery, surfactant protein A, B, and phospholipids change, and large-aggregate surfactant activity is reduced, impacting lung function.
Area of Science:
- Pediatric Surgery
- Pulmonary Medicine
- Biochemistry
Background:
- Infants under 1 year undergoing cardiopulmonary bypass (CPB) surgery often develop severe lung injury.
- This necessitates increased postoperative mechanical respiratory support.
- Mechanisms may involve impairment of the pulmonary surfactant system.
Purpose of the Study:
- To determine if surfactant changes occur in infants after CPB surgery.
- To investigate the biochemical and functional disturbances of the pulmonary surfactant system post-CPB.
- To explore the potential of surfactant substitution therapy.
Main Methods:
- Serial tracheobronchial small-volume lavages were collected from 19 infants (aged 166 days) undergoing CPB surgery.
- Lavages were fractionated into small and large surfactant aggregate fractions.
- Samples were compared to 13 healthy infants (aged 203 days) without lung disease.
Main Results:
- Total protein in lavages increased 3-4 fold post-CPB, decreasing over time.
- Surfactant protein A increased on days 1-2, while surfactant protein B and total phospholipids increased on day 1.
- Large-aggregate surfactant surface activity was impaired on days 1-3, though phospholipid ratios remained unchanged.
Conclusions:
- Lung injury post-CPB in infants involves significant biochemical and functional surfactant system disturbances.
- Surfactant substitution may correct these deficiencies.
- Further investigation is needed to assess surfactant therapy's potential to reduce postoperative morbidity.
Objective:
Infants younger than 1 year of age undergoing cardiopulmonary bypass surgery often have severe lung injury necessitating increased postoperative respiratory mechanical support. Inasmuch as the mechanisms may involve an impairment of the pulmonary surfactant system, our aim was to determine whether changes of surfactant occur in such infants.
Methods:
From the day of the operation to day 7 after the operation, serial tracheobronchial small-volume lavages of 19 infants (aged 166 +/- 29 days) were fractionated into a small and a large surfactant aggregate fraction and compared with those of 13 infants without lung disease (aged 203 +/- 33 days).
Results:
After cardiac operations with cardiopulmonary bypass surgery, total protein in lavages was increased 3-fold to 4-fold and decreased linearly with time. Surfactant protein A was increased on day 1 and day 2 and then decreased, whereas surfactant protein B and total phospholipids were increased on day 1. The ratio of phospholipids in small and large surfactant fractions was unchanged, but the surface activity of the large-aggregate surfactant was impaired on days 1 to 3.
Conclusions:
Lung injury in infants after cardiopulmonary bypass surgery involves significant biochemical and functional disturbances of the pulmonary surfactant system. Inasmuch as substitution with natural surfactant might correct these deficiencies, the potential of this approach to reduce postoperative morbidity needs to be investigated.