Continued Ventilation During Cardiopulmonary Bypass
Study Details
Study Description
Brief Summary
Cardiopulmonary bypass (CPB) is well known to induce a strong anti-inflammatory response. The investigators examined whether continued mechanical ventilation during CPB alters systemic immune activation.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
Cardiopulmonary bypass is well known to induce a strong anti-inflammatory response. Studies had been shown that the contact of blood components with artificial surfaces, the surgical trauma, endotoxemia and a reperfusion injury are in part responsible for the seen immunological affect after surgery. The purpose of this study is to test the effect of continued mechanical ventilation during surgery on a blood marker called soluble ST2 in patients sera. Soluble ST2 acts as a decoy receptor of IL-33 and has anti-inflammatory effects. Elevated soluble ST2 concentrations are reported in patients with acute myocardial infarction, sepsis, congestive heart failure and elevates soluble ST2 levels are associated with adverse outcome.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Ventilation Group Volume controlled ventilation was done during the whole surgery. |
Other: Lung Ventilation
In the ventilated group, mechanical ventilation was done with the half of the initial tidal volume (i.e. 3-4 ml/kg, 250-300ml) during the aortic cross-clamp.
|
| Active Comparator: Non-ventilation Group In the non-ventilated group lungs were collapsed after completion of CPB until after weaning from the extracorporeal circulation. |
Other: Non-ventilated Group
. In the non-ventilated group lungs were collapsed after completion of CPB until after weaning from the extracorporeal circulation.
|
Outcome Measures
Primary Outcome Measures
- Alteration of soluble ST2 concentration in serum [Preoperative, postoperative, day 1, day 2, day 3, day 4, day 5 after surgery]
Concentration of soluble ST2 will be assessed in the serum of patient´s preoperativem, postoperative and the following five consecutive days after surgery.
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Written informed consent
-
age > 40 and < 80
Exclusion Criteria:
-
treatment with steroids or immunomodulatory interventions during the past four weeks
-
signs of an acute infection
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Medical University of Debrecen | Debrecen | Hungary | Nagyerdei krt. 98 |
Sponsors and Collaborators
- Medical University of Vienna
Investigators
- Principal Investigator: Hendrik Jan Ankersmit, MD, Medical University of Vienna
Study Documents (Full-Text)
None provided.More Information
Publications
- Mildner M, Storka A, Lichtenauer M, Mlitz V, Ghannadan M, Hoetzenecker K, Nickl S, Dome B, Tschachler E, Ankersmit HJ. Primary sources and immunological prerequisites for sST2 secretion in humans. Cardiovasc Res. 2010 Sep 1;87(4):769-77. doi: 10.1093/cvr/cvq104. Epub 2010 Apr 2.
- Ng CS, Arifi AA, Wan S, Ho AM, Wan IY, Wong EM, Yim AP. Ventilation during cardiopulmonary bypass: impact on cytokine response and cardiopulmonary function. Ann Thorac Surg. 2008 Jan;85(1):154-62.
- Szerafin T, Brunner M, Horváth A, Szentgyörgyi L, Moser B, Boltz-Nitulescu G, Péterffy A, Hoetzenecker K, Steinlechner B, Wolner E, Ankersmit HJ. Soluble ST2 protein in cardiac surgery: a possible negative feedback loop to prevent uncontrolled inflammatory reactions. Clin Lab. 2005;51(11-12):657-63.
- Szerafin T, Hoetzenecker K, Hacker S, Horvath A, Pollreisz A, Arpád P, Mangold A, Wliszczak T, Dworschak M, Seitelberger R, Wolner E, Ankersmit HJ. Heat shock proteins 27, 60, 70, 90alpha, and 20S proteasome in on-pump versus off-pump coronary artery bypass graft patients. Ann Thorac Surg. 2008 Jan;85(1):80-7.
- Szerafin T, Horvath A, Moser B, Hacker S, Hoetzenecker K, Steinlechner B, Brunner M, Roth G, Boltz-Nitulescu G, Peterffy A, Wolner E, Ankersmit HJ. Apoptosis-specific activation markers in on- versus off-pump coronary artery bypass graft (CABG) patients. Clin Lab. 2006;52(5-6):255-61.
- Szerafin T, Niederpold T, Mangold A, Hoetzenecker K, Hacker S, Roth G, Lichtenauer M, Dworschak M, Wolner E, Ankersmit HJ. Secretion of soluble ST2 - possible explanation for systemic immunosuppression after heart surgery. Thorac Cardiovasc Surg. 2009 Feb;57(1):25-9. doi: 10.1055/s-2008-1039044. Epub 2009 Jan 23.
- 2894-2008