Search

The value of preoperative and early postoperative microbiologic testing of tracheal aspirates as a prognostic indicator of the development of pneumonia was evaluated in a prospective study of 213 cardiac surgical patients. Tracheal aspirates were obtained immediately after intubation and after the patient's arrival at the intensive care unit. Diagnosis of pneumonia was accepted if at least three of the following criteria were fulfilled: leukocytosis >15,000 cells/mm 3 , body temperature >38.5° C, positive results of auscultation, positive results of radiography (new infiltrates that seemed to be consistent with pneumonia), and increased core-reactive protein for more than 2 days after operation. Potentially pathogenic microorganisms were found in 54 (25.4%) of the preoperative tracheal aspirates and in 27 (12.7%) of the early postoperative tracheal aspirates. Positive microbiologic findings correlated with pneumonia in the postoperative course in 24.1% ( p < 0.001) if the preoperative culture results were positive, in 48.2% ( p < 0.001) if the postoperative culture results were positive, and in 44.0% ( p < 0.001) if both were positive. The risk of pneumonia was increased in male patients ( p < 0.05) and in patients with chronic obstructive pulmonary disease ( p < 0.05). Demographic variables, smoking, acute pulmonary symptoms, temperature, leukocyte count at the day of the operation, and data on the operation and the extracorporeal circulation were not significantly related to pneumonia in the early postoperative course. The risk of development of postoperative pneumonia is significantly higher among patients with colonization of the lower respiratory tract. Positive culture results in routine microbiologic monitoring of tracheal aspirates are predictive of pulmonary complications after cardiac operations. (J THORAC CARDIOVASC SURG 1996;111:1213-8)

1. Mohr FW, Falk V, Autschbach R, Diegeler A, Schorn B, Weyland A, et al. One-stage surgery of coronary arteries and abdominal aorta in patients with impaired left ventricular function. Circulation. 1995;91: 379-85. 2. Hollier LH, Plate G, O’Brien PC, Kazmier FJ, Gloviczki P, Pairolero PC. et al. Late survival after abdominal aortic aneurysm repair: influence of coronary artery disease. J Vasc Surg. 1984;1: 290-9. 3. Campa JS, Greenhalgh RM, Powell JT. Elastin degradation in abdominal aortic aneurysms. Atherosclerosis. 1987;65:13-21. 4. Kameda Y, Taniguchi S, Kawata T, Tabayashi N, Kimura M. Minimally invasive direct coronary artery bypass combined with abdominal aortic aneurysm repair. Ann Thorac Surg. 1999;68: 1537-9. 5. Ascione R, Iannelli G, Spampinato N. Combined coronary artery and abdominal aortic surgery without cardiopulmonary bypass. Tex Heart Inst J. 2000;27:19-23. 6. Ohki T, Veith FJ. Endovascular grafts and other image-guided catheter-based adjuncts to improve the treatment of ruptured aortoiliac aneurysms. Ann Surg. 2000;232:466-79.

Objectives: Cardiopulmonary bypass is associated with the release of proinflammatory cytokines (tumor necrosis factor α, interleukin 1β, interleukin 6, and interleukin 8) and anti-inflammatory cytokines (interleukin 10 and transforming growth factor β1). On the one hand this cytokine release is related to the postoperative systemic inflammatory response syndrome, and on the other hand it is related to deterioration of the immune system, for example in monocyte or polymorphonuclear neutrophil function, leading to an increased susceptibility to infections. To gain further insight into the alterations of immune cell reactivity and possible regulatory mechanisms, we studied lipopolysaccharide-induced tumor necrosis factor α synthesis in whole blood from cardiac surgical patients. Methods: Fifteen patients undergoing elective heart surgery with cardiopulmonary bypass were included in the study. Ex vivo lipopolysaccharide-induced tumor necrosis factor α synthesis was measured in a whole blood assay before, during, and after bypass. Corresponding tumor necrosis factor α messenger RNA levels were determined by semiquantitative reverse transcriptase-polymerase chain reaction. In addition, the influence of patient serum on whole blood responsiveness and its relationship to anti-inflammatory cytokines were evaluated in vitro. Results: Tumor necrosis factor α synthesis was significantly reduced after 30 minutes of cardiopulmonary bypass and showed the lowest values at the end of bypass (mean ± SD 0.109 ± 0.105 ng/106 white blood cells after 30 minutes of bypass and 0.050 ± 0.065 ng/106 white blood cells at the end of bypass, vs 0.450 ± 0.159 ng/106 white blood cells preoperatively, P