Skip to content

Advertisement

  • Poster presentation
  • Open Access

Does the use of a cytokine 'filter' during cardiopulmonary bypass make sense?

  • 1,
  • 1,
  • 2,
  • 2,
  • 1 and
  • 1
Critical Care20048 (Suppl 1) :P149

https://doi.org/10.1186/cc2616

  • Published:

Keywords

  • Cardiopulmonary Bypass
  • Initial Stress
  • Acute Inflammation
  • Hemorrhagic Shock
  • Adsorbent Polymer

Objective

Very high or sustained high levels of the inflammatory cytokines tissue necrosis factor (TNF) and interleukin (IL)-6 are believed to be responsible for adverse clinical effects in patients undergoing cardiopulmonary bypass (CPB). We explored, using a mathematical model, whether modulation of this response might be beneficial.

Methods

We developed a mathematical model of the acute inflammatory response that was calibrated from rat endotoxemia and hemorrhagic shock data. The model accommodates a variety of initiators of acute inflammation, provides a dynamic profile of serum markers of inflammation over time, and expresses outcome in as global tissue dysfunction. Irreversible dysfunction is interpreted as death. We constructed a population of 100,000 cases that differed by level of initial stress and propensity to mount an inflammatory response. Initial stress was chosen to result in 4% cohort mortality and to last less than 6 hours, such as CPB. The intervention consisted of the removal of circulating TNF, IL-6 and IL-10 over a period of 6 hours, during which stress was inflicted and acute inflammation triggered. We equated the degree of removal of cytokines to that observed with the application of a biocompatible adsorbent polymer hemoperfusion column in endotoxemic rats.

Results

Death correlated to serum IL-6 and to a lesser degree TNF cumulative levels. Patients with the highest levels of IL-6 6–24 hours after the insult are those that will go on to die (Fig. 1). Examination of the results show that, if the IL-6 levels were decreased by > 60% and TNF levels by > 50% in the period at or shortly after the CPB, over 99% of all patients would survive, compared with 96% in the control arm.

Figure 1

Conclusions

Global, nonspecific, reduction of inflammation improves outcome in simulations of an acute inflammatory challenge such as CPB.

Authors’ Affiliations

(1)
University of Pittsburgh, Pennsylvania, USA
(2)
Immunetrics, Inc., Pittsburgh, Pennsylvania, USA

Copyright

© BioMed Central Ltd. 2004

Advertisement