The use of ultrafiltration for inflammatory mediators removal during cardiopulmonary bypass in coronary artery bypass graf surgery

Revista Brasileira de Cirurgia Cardiovascular

Nilson Antunes¹  Desanka Dragosavc²  Orlando Petrucci Junior²  Pedro Paulo Martins De Oliveira¹  Carolina Kosour²  Maria Heloisa Souza Lima Blotta²  Domingo Marcolino Braile²  Reinaldo Wilson Vieira² 

[1] ,Universidade Estadual de Campinas Hospital de Clínicas

关键词: Extracorporeal circulation;    Ultrafiltration;    Cytokines;    Multiple organ failure;    Circulação extracorpórea;    Ultrafiltração;    Citocinas;    Falência de múltiplos órgãos;   

DOI  :  10.1590/S0102-76382008000200005

来源: SciELO

【 摘 要 】

OBJECTIVE: To investigate the effectiveness of ultrafiltration in removing inflammatory mediators released by cardiopulmonary bypass and to correlate ultrafiltration with alterations in organic function according to the Sequential Organ Failure Assessment Score. METHODS: Forty patients were included and randomized into two groups: "no ultrafiltration" (n=20; Group I) and "ultrafiltration" (n=20; Group II). Activated complement 3 and 4, interleukins 1beta, 6, 8 and tumor necrosis factor alfa were measured prior to anesthesia induction (Time 1), 5 minutes before cardiopulmonary bypass (Time 2), in the ultrafiltrated fluid (Time 3), 30 minutes (Time 4), and 6 (Time 5), 12 (Time 6), 24 (Time 7), 36 (Time 8) and 48 (Time 9) hours following cardiopulmonary bypass. Sequential Organ Failure Assessment Score was evaluated at Time 1, 6 and 9. Statistical significance was established at p < 0.05. RESULTS: In the ultrafiltrated fluid, only tumor necrosis factor alfa levels were detected. Levels of activated complement 3 at Times 5 and 7 and activated complement 4 at Times 5 and 6 were significantly higher in the unfiltered Group, and levels of interleukin 6 were higher in the filtered Group at Times 7 and 8. Interleukins 1beta, 8, tumor necrosis factor alfa, and the Sequential Organ Failure Assessment score were not significantly different between the groups. CONCLUSIONS: Ultrafiltration significantly filtered tumor necrosis factor alfa but did not influences serum levels of this cytokine. Ultrafiltration with the type of filter used in this study had no effect in organic dysfunction and should be used only for volemic control in patients undergo cardiopulmonary bypass.

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