Analysis of the course of inflammation in the two compartments blood and intra-alveolar space in reaction to cardiopulmonary bypass (CPB)

• Published in: The Thoracic and Cardiovascular Surgeon
• Main Authors: Rost, A, Fra, O, Buehling, F, Huth, C, Welte, T
• Format: Conference Proceeding
• Language: English; German
• Published: 30.01.2004
• ISSN: 0171-6425; 1439-1902
• DOI: 10.1055/s-2004-816704

Objective: CPB triggers a systemic inflammation due to damage in cellular immune competence and consecutive pulmonary dysfunction as the most common clinical manifestation. The relation between systemic and broncho-alveolar or intra-alveolar courses of inflammation is not fully known. Methods: From 61 patients undergoing open-heart surgery (18 female, 43 male, age 62.48±8.99 years) blood samples and BALF (BAL fluid) specimens were obtained simultaneously immediately after induction of anaesthesia (intubation) and 2h after completion of CPB (postoperative). MRP8+, MRP14+, 27E10+, RM3/1+, 25F9+ granulocytes (G) and monocytes/makrophages (Mo/Mph) were analysed (cytofluorimetry). Statistics were confirmed by the Wilcoxon-signed-rank-test (p-value ≤0.05 statistically significant, p-value ≤0.001 highly significant). Results: The BALF exhibited only little perioperative changes exceptionally a loss in the percentage of 25F9+ cells (G: p=0.037; Mph: p=0.031). The blood samples showed a constant percentage of 27E10+ monocytes, but all other parameters were markedly reduced (p<0.001 for G: MRP8+, MRP14+, 27E10+, RM3/1+, 25F9+; for Mo: p=0.02 MRP8+, p=0.016 MRP14+, p<0.001 RM3/1+, p=0.06 25F9+). Conclusion: Reflecting the markers of inflammation we postoperatively demonstrated an acute state of inflammation in blood and an intermediate one in the intra-alveolar space. So we consider blood and pulmonary space as two distinct and different immunological compartments in relation with CPB. We regard results from systemic blood exclusively as not suffice to assess the pulmonary immune state or course of inflammation.