Avaliação dos níveis de citocinas e da função pulmonar de pacientes submetidos à cirurgia cardíaca com circulação extracorpórea

Luciano Brandão Machado; Elnara Marcia Negri; Wanderley Wesley Bonafé; Luciana Moraes Santos; Luís Marcelo Sá Malbouisson; Maria José Carvalho Carmona

doi:10.1590/S0034-70942011000300002

Scientific Article

Avaliação dos níveis de citocinas e da função pulmonar de pacientes submetidos à cirurgia cardíaca com circulação extracorpórea

Evaluation of cytokine levels and pulmonary function in patients undergoing coronary artery bypass graft

Luciano Brandão Machado; Elnara Marcia Negri; Wanderley Wesley Bonafé; Luciana Moraes Santos; Luís Marcelo Sá Malbouisson; Maria José Carvalho Carmona

http://dx.doi.org/10.1590/S0034-70942011000300002 Braz J Anesthesiol, vol.61, n3, p.280-285, 2011

PDF

Downloads: 0

Resumo

JUSTIFICATIVA E OBJETIVOS: A Síndrome da Resposta Inflamatória Sistêmica é uma ocorrência habitual em cirurgias cardíacas com circulação extracorpórea (CEC). O objetivo deste estudo foi avaliar os níveis sistêmicos e pulmonares de citocinas e a correlação com a função pulmonar em pacientes submetidos à revascularização miocárdica (RM) com CEC. MÉTODOS: O estudo foi aprovado pela Comissão de Ética institucional, com a avaliação de 13 pacientes submetidos à RM com CEC. Após a indução anestésica, ao término da CEC, realizaram-se dosagens plasmáticas e no lavado broncoalveolar de IL-1β, IL-6, IL-8, IL-10 e TNF-α. Foram avaliados o tempo de CEC e de cirurgia, a relação PaO2/FiO2, o gradiente alvéolo-arterial de oxigênio (GA-aO2), o shunt e a complacência pulmonares. Os resultados foram submetidos à análise de variância para medidas repetidas (*p < 0,05) e coeficiente de correlação de Spearman. RESULTADOS: Observaram-se aumento dos níveis de citocinas no plasma e no lavado broncoalveolar após a CEC e relação direta entre o aumento da IL-1β e a diminuição da complacência pulmonar (p = 0,0439), assim como relação inversa entre o aumento da IL-10 e a redução da complacência (p = 0,0325). O aumento da IL-6 teve relação direta com o tempo de CEC (p = 0,012), enquanto o aumento da IL-8 teve relação direta com o tempo de cirurgia (p < 0,0001). Os níveis de IL-1β, IL-8 e TNF-α foram maiores no LBA em relação ao plasma. CONCLUSÕES: Ocorre aumento dos níveis de citocinas no plasma e lavado broncoalveolar após a CEC e há correlação entre o aumento dos níveis de citocinas e o tempo de CEC e de cirurgia e as alterações na complacência pulmonar.

Palavras-chave

CIRURGIA, Cardíaca, EQUIPAMENTOS, Oxigenador, FARMACOLOGIA, FISIOPATOLOGIA, TÉCNICAS DE MEDIÇÃO, Testes de função pulmonar

Abstract

BACKGROUND AND OBJECTIVES: Systemic inflammatory response syndrome is commonly observed in coronary artery bypass grafts (CABG) with cardiopulmonary bypass (CB). The objective of this study was to evaluate the systemic and pulmonary levels of cytokines and their correlation with lung function in patients undergoing myocardial revascularization (MR) with CB. METHODS: This study was approved by the Institutional Ethics Committee, and 13 patients undergoing MR with CB were evaluated. After anesthetic induction and at the end of CB, plasma and bronchoalveolar lavage levels of IL-1β, IL-6, IL-8, IL-10, and TNF-α were determined. The dur ation of CB and surgery, PaO2/FiO2 ratio, alveolar-arterial oxygen gradient (A-a gradient), shunt, and lung compliance were evaluated. Results were submitted to analysis of variance for repeated measurements (*p < 0.05) and Spearman's correlation coefficient. RESULTS: We observed increased levels of cytokines in plasma and bronchoalveolar lavage after CB and a direct relationship between the increase in IL-1β and decrease in lung compliance (p = 0.0439), as well as the inverse relationship between the increase in IL-10 and a decrease in compliance (p = 0.0325). The increase in IL-6 was directly related to the duration of CB (p = 0.012), while the increase in IL-8 was directly related to the duration of surgery (p < 0.0001). Levels of interleukin-1β, IL-8, and TNF-α in bronchoalveolar lavage were higher than in plasma. CONCLUSIONS: There is an increase in cytokine levels in plasma and bronchoalveolar lavage after CB, as well as a correlation between increased cytokine levels and CB duration and surgery and changes in lung compliance.

Keywords

Cytokines, Myocardial Revascularization, Extracorporeal Circulation, Systemic Inflammatory Response Syndrome, Respiratory Function Tests

References

Hall RI, Smith MS, Rocker G. The systemic inflammatory response to cardiopulmonary bypass: pathophysiological, therapeutic, and pharmacological considerations. Anesth Analg. 1997;85:766-782.

Kollef MH, Wragge T, Pasque C. Determinants of mortality and multiorgan dysfunction in cardiac surgery patients requiring prolonged mechanical ventilation. Chest. 1995;107:1395-1401.

Cotran RS, Kumar V, Robins SL. Inflammation and Repair. Robbins Pathologic Basis of Disease. 1994:51-94.

Laffey JG, Boylan JF, Cheng DC. The systemic inflammatory response to cardiac surgery: implications for the anesthesiologist. Anesthesiology. 2002;97:215-252.

Gerlach H, Keh D. Sepsis in 2003: are we still in the middle of nowere?. Curr Opin Anaesthesiol. 2004;17:97-106.

Bennett-Guerrero E. Systemic Inflammation. Cardiac Anesthesia. 1999:297-318.

Loisa P, Rinne T, Laine S. Anti-inflammatory cytokine response and the development of multiple organ failure in severe sepsis. Acta Anaesthesiol Scand. 2003;47:319-325.

Brix-Christensen V. The systemic inflammatory response after cardiac surgery with cardiopulmonary bypass in children. Acta Anaesthesiol Scand. 2001;45:671-679.

Brix-Christensen V, Vestergaard C, Chew M. Plasma cytokines do not reflect expression of pro- and anti-inflammatory cytokine mRNA at organ level after cardiopulmonary bypass in neonatal pigs. Acta Anaesthesiol Scand. 2003;47:525-531.

Crestani B, Cornillet P, Dehoux M. Alveolar type II epithelial cells produce interleukin-6 in vitro and in vivo: Regulation by alveolar macrophage secretory products. J Clin Invest. 1994;94:731-740.

Friedman M, Sellke FW, Wang SY. Parameters of pulmonary injury after total or partial cardiopulmonary bypass. Circulation. 1994;90(5):II262-268.

Massoudy P, Zahler S, Becker BF. Evidence for inflammatory responses of the lungs during coronary artery bypass grafting with cardiopulmonary bypass. Chest. 2001;119:31-36.

Higgins TL, Estafanous FG, Loop FD. Stratification of morbidity and mortality outcome by preoperative risk factors in coronary artery bypass patients: A clinical severity score. Jama. 1992;267:2344-2348.

Crystal RG, Reynolds HY, Kalica AR. Bronchoalveolar lavage: The report of an international conference. Chest. 1986;90:122-131.

Crespo A, Carvalho AF. Capnografia. Monitorização Respiratória em UTI. 1998:283-298.

Shapiro SS, Wilk MB. An analysis of variance test for normality (complete samples). Biometrika. 1965;52:591-611.

Rosner B. Fundamentals of Biostatistics. 1986:575-579.

Winer BJ. Statistical Principles in Experimental Design. 1971.

Goldman L, Hashimoto B, Cook EF. Comparative reproducibility and validity of systems for assessing cardiovascular functional class: advantages of a new specific activity scale. Circulation. 1981;64:1227-1234.

Wan S, DeSmet JM, Barvais L. Myocardium is a major source of proinflammatory cytokines in patients undergoing cardiopulmonary bypass. J Thorac Cardiovasc Surg. 1996;112:806-811.

Oberholzer A, Oberholzer C, Moldawer LL. Cytokine signaling regulation of the immune response in normal and critically ill states. Crit Care Med. 2000;28(4^ssuppl):N3-12.

Prondzinsky R, Knupfer A, Loppnow H. Surgical trauma affects the proinflammatory status after cardiac surgery to a higher degree than cardiopulmonary bypass. J Thorac Cardiovasc Surg. 2005;129:760-766.

Babik B, Asztalos T, Petak F. Changes in respiratory mechanics during cardiac surgery. Anesth Analg. 2003;96:1280-1287.

Machado LB, Santos LM, Negri EM. Broncho-alveolar lavage cellularity in patients submitted to myocardial revascularization with cardiopulmonary bypass: three case reports. Rev Bras Anestesiol. 2006;56:263-272.

Landis RC. Redefining the systemic inflammatory response. Semin Cardiothorac Vasc Anesth. 2009;13:87-94.

Levy JH, Tanaka KA. Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg. 2003;75:S715-720.

Paparella D, Yau TM, Young E. Cardiopulmonary bypass induced inflammation: pathophysiology and treatment. An update. Eur J Cardiothorac Surg. 2002;21:232-244.

Fillinger MP, Rassias AJ, Guyre PM. Glucocorticoid effects on the inflammatory and clinical responses to cardiac surgery. J Cardiothorac Vasc Anesth. 2002;16:163-169.

Webster NR, Galley HF. Immunomodulation in the critically ill. Br J Anaesth. 2009;103:70-81.

Niemann JT, Youngquist S, Rosborough JP. Infliximab attenuates early myocardial dysfunction after resuscitation in a swine cardiac arrest model. Crit Care Med. 2010;38:1162-1167.

Tomasdottir H, Hjartarson H, Ricksten A. Tumor necrosis factor gene polymorphism is associated with enhanced systemic inflammatory response and increased cardiopulmonary morbidity after cardiac surgery. Anesth Analg. 2003;97:944-949.

Galley HF, Lowe PR, Carmichael RL. Genotype and interleukin-10 responses after cardiopulmonary bypass. Br J Anaesth. 2003;91:424-426.

Lin MT, Albertson TE. Genomic polymorphisms in sepsis. Crit Care Med. 2004;32:569-579.

Bilgin YM, van de Watering LMG, Versteegh MIM. Effects of allogeneic leukocytes in blood transfusions during cardiac surgery on inflammatory mediators and postoperative complications. Crit Care Med. 2010;38:546-552.

Avaliação dos níveis de citocinas e da função pulmonar de pacientes submetidos à cirurgia cardíaca com circulação extracorpórea

Evaluation of cytokine levels and pulmonary function in patients undergoing coronary artery bypass graft

Luciano Brandão Machado; Elnara Marcia Negri; Wanderley Wesley Bonafé; Luciana Moraes Santos; Luís Marcelo Sá Malbouisson; Maria José Carvalho Carmona

Resumo

Palavras-chave

Abstract

Keywords

References

Links

Share

Braz J Anesthesiol