1. Changes in cysteinyl leukotrienes during and after cardiac surgery with cardiopulmonary bypass in patients with and without chronic obstructive pulmonary disease.
- Author
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de Prost N, El-Karak C, Avila M, Ichinose F, and Vidal Melo MF
- Subjects
- Aged, Analysis of Variance, Biomarkers blood, Biomarkers urine, Boston, Chi-Square Distribution, Enzyme-Linked Immunosorbent Assay, Heart Diseases immunology, Heart Diseases physiopathology, Humans, Leukotriene B4 blood, Leukotriene B4 urine, Lung physiopathology, Middle Aged, Neutrophil Activation, Prospective Studies, Pulmonary Disease, Chronic Obstructive physiopathology, Pulmonary Gas Exchange, Respiration, Artificial, Respiratory Mechanics, Severity of Illness Index, Time Factors, Treatment Outcome, Cardiac Surgical Procedures adverse effects, Cardiopulmonary Bypass adverse effects, Cysteine blood, Cysteine urine, Heart Diseases surgery, Inflammation Mediators blood, Inflammation Mediators urine, Leukotrienes blood, Leukotrienes urine, Pulmonary Disease, Chronic Obstructive immunology
- Abstract
Objective: Pulmonary function frequently deteriorates after cardiopulmonary bypass (CPB). Chronic obstructive pulmonary disease (COPD) increases risk of respiratory complications after CPB. Cysteinyl leukotrienes are important mediators of respiratory dysfunction. Their role during cardiac surgery and its lung complications is incompletely understood. We studied whether production of cysteinyl leukotrienes changes during and after cardiac surgery with CPB and differs between patients with and without COPD., Methods: Patients with (n = 9) and without (n = 10) moderate-to-severe COPD undergoing cardiac surgery with CPB were prospectively included. Plasma and urinary cysteinyl leukotriene and leukotriene B(4) concentrations were measured by enzyme-linked immunosorbent assay after anesthesia induction, at end of CPB, after CPB, and 2 hours after intensive care unit admission. Gas exchange and respiratory mechanics were also assessed., Results: Patients with COPD had larger airway resistances after CPB and chest closure (P < .001), lower ratio of arterial Po(2) to inspired oxygen fraction at intensive care unit admission (215 ± 37 vs 328 ± 30 mm Hg, P < .05), and longer postoperative mechanical ventilation (13.7 ± 5.8 vs 6.8 ± 3.4 hours, P < .01). Urinary cysteinyl leukotriene concentrations increased with time in both groups (P < .01), but more in patients with than without COPD (P < .05). Plasma cysteinyl leukotriene concentrations increased significantly between baseline and intensive care unit admission in patients with but not without COPD (P < .01). Concentrations of leukotriene B(4) in plasma and urine did not increase significantly with time and were not different between groups., Conclusions: Release of cysteinyl leukotrienes increases during cardiac surgery with CPB and is larger in patients with than without COPD. This may be related to higher lung and airway production of cysteinyl leukotrienes and neutrophil activation in patients with COPD., (Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.)
- Published
- 2011
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