Mechanical and pharmacological strategies to reduce the systemic inflammatory response during CABG
© Current Science Ltd 1999
Published: 2 March 1999
Zero-balanced and modified ultrafiltration are known to reduce the systemic inflammatory response syndrome (SIRS) during pediatric cardiopulmonary bypass (CPB), while corticosteroids have been used successfully in adult patients. Thus, the aim of this study was to compare the effect of mechanical to pharmacological strategies in respect to SIRS in adult patients.
In a prospective, randomized, controlled study, 73 patients were enrolled. In Group UF patients (n = 21), zero-balanced ultrafiltration was performed during re-warming and modified ultrafiltration immediately after CPB. In Group MP patients (n = 26), 1 g methylprednisolone was given 30 min before CPB. The Group C patients (n = 26), received placebo instead.
After CPB the concentration of interleukin(IL)-6 was significantly lower in Group UF and in Group MP compared with Group C (105 ± 20 and 124 ± 29 vs 203 ± 46 pg/ml, respectively; P < 0.05, mean ± SEM). Anti-inflammatory IL-10 showed a significant (P < 0.01) peak after CPB in Group MP as compared to Group UF and also to Group C. In Group UF, intrapulmonary shunt fraction decreased during modified ultrafiltration from 31 ± 1.2 to 25 ± 1.3% while PaO2 and mean arterial pressure increased (P < 0.01). After CPB the PaO2 and also oxygen distribution in Group MP were higher (P < 0.05) as compared with Group C patients. Extubation-time was shorter in the UF-group compared to the Group C patients (6.1 ± 0.5 vs 8.6 ± 0.7 h, respectively; P < 0.05).
The combination of zero-balanced and modified ultrafiltration reduces SIRS immediately after CPB, resulting in higher arterial pressure, improved pulmonary gas exchange, and shorter need of respiratory support. Methylprednisolone led to a marked reduction of the pro-inflammatory and an increase of anti-inflammatory response. Both strategies to reduce SIRS had positive influence on clinical parameters.