Chest
ReviewsPulmonary Dysfunction After Cardiac Surgery
Section snippets
The Phenomenon
Lung injury after CPB is evident by the presence of postoperative pulmonary functional, physiologic, biochemical, and histologic changes.
How Much of the Lung Injury Is CPB-Related?
Few would argue about the presence of lung injury following CPB. However, pulmonary dysfunction after CPB may be the result of multiple insults from various aspects of CPB surgery.25,26 These include extra-CPB factors (ie, general anesthesia, sternotomy, and breach of the pleura) and intra-CPB factors (ie, blood contact with artificial material, administration of heparin-protamine, hypothermia, cardiopulmonary ischemia, and lung ventilatory arrest).26 Thus, it is questionable whether lung
PMN Activation
It is well-known that CPB primes and activates polymorphonuclear cells (PMNs) through mechanical shear stress38,39 and contact with the artificial surfaces of the CPB circuit. Proinflammatory mediators can subsequently promote lung injury by augmenting PMN activation.26,40 For instance, several cytokines such as interleukin (IL)-1,41 IL-2,42 IL-6, IL-8,43 and tumor necrosis factor (TNF)-α,41,42 have been shown to promote PMN activation and recruitment. In addition, platelet-activating factor,
Pharmaceuticals
The commonly scrutinized pharmacologic agents with which to treat pulmonary dysfunction are corticosteroids and aprotinin. Corticosteroid administration before CPB has been shown to reduce the release of proinflammatory mediators such as IL-6, IL-8, and TNF-α,26 although there was little effect on complement activation.65,66,67 In addition, methylprednisolone therapy can inhibit neutrophil CD11b expression51 and neutrophil complement-induced chemotaxis,67 thereby decreasing neutrophil
Summary
Although severe lung injury after CPB is uncommon, it remains a significant cause of morbidity and mortality with a major impact on health-care expenditures. There is little doubt that CPB is associated with pulmonary dysfunction, as supported by the ample experimental and clinical evidence of chemical, cellular, and pulmonary functional disturbances after CPB. However, whether CPB itself is directly responsible for postoperative lung dysfunction is still controversial. Some studies have shown
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Cited by (0)
This study was supported in part by the Direct Grant for Research (Chinese University of Hong Kong No. CRE-2001–021) and the Research Grant Council Earmarked Grant (Chinese University of Hong Kong No. 4310/99M), Hong Kong SAR.