Abstract
Aortic surgery results in ischemia–reperfusion injury that induces an inflammatory response and frequent complications. The magnitude of the inflammatory response in blood and bronchi may be associated with the risk of immediate complications. The purpose of the study was to evaluate bronchial microdialysis as a continuous monitoring of cytokines in bronchial epithelial lining fluid (ELF) and to determine whether bronchial ELF cytokine levels reflect the ischemia–reperfusion injury and risk for complications during open abdominal aortic aneurysm (AAA) repair. We measured cytokines in venous blood using microdialysis and in serum for comparison. Sixteen patients scheduled for elective open AAA repair were included in a prospective observational study. Microdialysis catheters were introduced into a bronchi and a cubital vein. Eighteen cytokines were measured using a Bio‐Plex Magnetic Human Cytokine Panel. Samples were collected before and during cross‐clamping of the aorta as well as from 0 to 60 min and from 60 to 120 min of reperfusion. The ELF levels of several cytokines changed significantly during reperfusion. In particular, IL‐6 increased more than 10‐fold and IL‐13 more than 5‐fold during ischemia and reperfusion. Also, the venous levels of several inflammatory and anti‐inflammatory cytokines increased and exhibited their highest concentration during reperfusion. Both bronchial and venous cytokine levels correlated with duration of the procedure, intensive care days, and preoperative kidney disease. Three patients suffered organ failure as a direct consequence of the procedure, and in these patients the bronchial ELF concentrations of 17 of 18 cytokines differed significantly from patients without such complications. Bronchial microdialysis is suited for continuous monitoring of inflammation during open AAA repair. The bronchial ELF cytokine levels may be useful in predicting immediate complications such as organ failure in patients undergoing vascular surgery.
Highlights
Patients undergoing major vascular surgery are prone to complications such as peri- and postoperative respiratory and renal failure
We have previously shown that detection of substances in the epithelial lining fluid (ELF) by bronchial microdialysis (BMD) is superior to measurements in serum samples for detecting inflammation in a pig model of intestinal ischemia–reperfusion (IR) injury, which suggests that bronchial cytokine concentrations could be a warning sign and a criterion to expedite clinical decision making (Tyvold et al 2007, 2010)
In view of our data with substantial higher concentrations measured in the bronchi compared to the venous circulation, we suggest that the production of cytokines is compartmentalized, and that the bronchial cytokines are produced in the lung in response to the surgical trauma from open abdominal aortic aneurysm (AAA) repair
Summary
Patients undergoing major vascular surgery are prone to complications such as peri- and postoperative respiratory and renal failure. It is a major challenge to identify patients at risk for a complicated course. Besides patient characteristics such as smoking, diabetes, obesity, and renal failure, perioperative measures such as duration of the procedure are predictors for complications during vascular surgery. Several studies have shown that an enhanced inflammatory response during surgery seems to reflect an increased risk for complications in these patients elevated cytokine levels have been associated with respiratory failure and increased mortality in patients undergoing aortic surgery (Roumen et al 1993; Cornet et al 2009). Microdialysis is a minimally invasive technique used to explore tissue chemistry within target organs and has gained attention in studies on pharmacokinetics of antibiotic drugs in the lungs, as well as a valid “bedside” method to detect acute ischemia and in measurements of inflammatory markers that predict organ rejection in transplantation surgery (Herkner et al 2002; Aoki et al 2008; Nielsen et al 2011; Haugaa et al 2012)
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