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  • Open Access

Endotoxemia related to cardiopulmonary bypass is associated with increased risk of infection after cardiac surgery

  • 1,
  • 1,
  • 1,
  • 1 and
  • 1
Critical Care201115 (Suppl 1) :P7

https://doi.org/10.1186/cc9427

  • Published:

Keywords

  • Observational Study
  • Primary Outcome
  • Emergency Medicine
  • Secondary Outcome
  • Cardiopulmonary Bypass

Introduction

The purpose of this study was to examine the prevalence of endotoxemia-supported aortocoronary bypass grafting surgery (ACB), using the endotoxin activity assay (EAA), and to explore the association between endotoxemia and postoperative infection.

Methods

The study was a single-center prospective observational study measuring EAA during the perioperative period for elective ACB. Blood samples were drawn at induction of anesthesia (T1), immediately prior to release of the aortic cross-clamp (T2), and on the first postoperative morning (T3). The primary outcome was the prevalence of endotoxemia. The secondary outcome was rate of postoperative infection. An EAA of <0.40 was interpreted as low, 0.41 to 0.59 as intermediate, and >0.60 as high.

Results

Fifty-seven patients were enrolled and 54 patients were analyzable. The mean EAA at T1 was 0.38 ± 0.14, at T2 0.39 ± 0.18, and at T3 0.33 ± 0.18. At T2 only 13.5% of patients had an EAA in the high range. There was a positive correlation between EAA and the duration of cross-clamp (P = 0.02). Eight patients developed postoperative infections (14.6%). EAA at T2 was strongly correlated with the risk of postoperative infection (P = 0.02) as was the maximum EAA over the first 24 hours (P = 0.02). See Figure 1.
Figure 1
Figure 1

Endotoxin levels in subjects with and without postoperative infections.

Conclusions

High levels of endotoxin occurred less frequently during ACB than previously documented. However, endotoxemia is associated with a significantly increased risk of the development of postoperative infection - a complication associated with an over doubling of risk of death. Measuring endotoxin levels may provide a mechanism to identify and target a high-risk population.

Authors’ Affiliations

(1)
St Michael's Hospital, Toronto, Canada

Copyright

© Klein et al. 2011

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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