Cardiopulmonary Bypass In Humans Research Articles

Neutrophil function and cardiopulmonary bypass in humans. The effects of glucose and non-glucose containing bypass pump priming fluids

Defective polymorphonuclear neutrophil function during cardiopulmonary bypass (CPB) has been implicated as a cause of postoperative infection following open-heart surgery. Neutrophil function is known to be impaired in poorly controlled diabetics with elevations of blood glucose concentrations of the order which occur frequently during CPB when glucose containing priming fluids are used. Neutrophil function, as measured by bactericidal assay, and neutrophil and whole blood luminol dependent chemiluminescence, was studied in two groups of 1 2 patients undergoing coronary artery bypass graft surgery. Patients received either a glucose or non-glucose containing bypass pump-priming fluid. Postoperatively neutrophil luminol-dependent chemiluminescence was significantly increased in both groups (glucose prime groups p < 0.01, non-glucose prime group p < 0.01). Whole blood chemiluminescence was increased significantly intra and postoperatively in the glucose prime group ( p < 0.02, p < 0.02 respectively) but the increase was not significant in the non-glucose prime group. Bactericidal activity remained unchanged during and after surgery in both groups (mean bactericidal index intraoperatively 96.4 glucose group, 96.2 non-glucose group; postoperatively 99.7 glucose group, 99.7 non-glucose group). These data suggest that glucose containing bypass priming fluids do not modulate significantly the function of circulating neutrophils after CPB. Neutrophil function was not decreased after surgery, and other factors may be responsible for the reported higher incidence of bacterial infection after CPB.

Prostaglandin E2, prostacyclin, and thromboxane changes during nonpulsatile cardiopulmonary bypass in humans

To study the effect of lung bypass on the production of prostaglandin E2, prostacyclin, and thromboxane A2, we measured simultaneously arterial and venous plasma concentrations of prostaglandin E2, 6-keto-prostaglandin F1 alpha (stable metabolite of prostacyclin), and thromboxane B2 (stable metabolite of thromboxane A2) before, during, and after cardiopulmonary bypass. Seventeen patients (age range 46 to 69 years) undergoing aorta-coronary bypass grafts were investigated. The prostaglandin E2 production rose sharply immediately after the onset of bypass (baseline: 9.7 +/- 2.9 pg/ml to 85 +/- 16.6 pg/ml in venous and 87 +/- 12 pg/ml in arterial plasma, p less than 0.03) and rapidly decreased after pulmonary reperfusion (53 +/- 6.4 and 57 +/- 20 pg/ml, respectively, in venous and arterial plasma at the end of bypass). The increase in prostaglandin E2 was influenced by the heart-lung machine itself (as demonstrated by a closed "bypass" circuit) and by lung bypass. Pulmonary metabolism of prostaglandin E2 was maintained after bypass. The prostacyclin production rose significantly at the beginning of bypass (154 +/- 26 pg/ml venous prebypass level to 361 +/- 94 pg/ml after aortic clamping, p less than 0.03). Prostacyclin decreased progressively during rewarming of the patient, pulmonary reperfusion, and discontinuation of bypass. When prostacyclin decreased, thromboxane B2 production rose significantly and reached peak arterial levels when the lungs were reperfused (112 +/- 33 pg/ml prebypass levels to 402 +/- 101 pg/ml, p less than 0.01). Except for prostaglandin E2, there were no significant differences between arterial and venous plasma levels of these substances. The same prostanoids were also measured in five patients undergoing major orthopedic operations, and no significant changes in prostanoids were observed. Our data demonstrate significant production of prostaglandin E2 in the systemic circulation during cardiopulmonary bypass in humans. They further indicate that lung bypass disturbs the plasma prostaglandin/thromboxane balance.

Brain Luxury Perfusion during Cardiopulmonary Bypass in Humans. A Study of the Cerebral Blood Flow Response to Changes in CO2, O2, and Blood Pressure

CBF and related parameters were studied in 68 patients before, during, and following cardiopulmonary bypass. CBF was measured using the intraarterial 133Xe injection method. The extracorporeal circuit was nonpulsatile with a bubble oxygenator administering 3-5% CO2 in the main group of hypercapnic patients (n = 59) and no CO2 in a second group of hypocapnic patients. In the hypercapnic patients, marked changes in CBF occurred during bypass. Evidence was found of a brain luxury perfusion that could not be related to the effect of CO2 per se. Mean CBF was 29 ml/100 g/min just before bypass, 49 ml/100 g/min at steady-state hypothermia (27 degrees C), reached a maximum of 73 ml/100 g/min during the rewarming phase (32 degrees C), fell to 56 ml/100 g/min at steady-state normothermic bypass (37 degrees C), and was 48 ml/100 g/min shortly after bypass was stopped. Addition of CO2 evoked systemic vasodilation with low blood pressure and a rebound hyperemia. The hypocapnic group responded more physiologically to the induced changes in hematocrit (Htc) and temperature, CBF being 25, 23, 25, 34, and 35 ml/100 g/min, respectively, during the five corresponding periods. Carbon dioxide was an important regulator of CBF during all phases of cardiac surgery, the responsiveness of CBF being approximately 4% for each 1-mm Hg change of PaCO2. The level of MABP was important for the CO2 response. At low blood pressure states, the CBF responsiveness to changes in PaCO2 was almost abolished. An optimal level of PaCO2 during hypothermic bypass of approximately 25 mm Hg (at actual temperature) is recommended. A normal autoregulatory response of CBF to changes in blood pressure was found during and following bypass. The lower limit of autoregulation was at pressure levels of approximately 50-60 mm Hg. CBF autoregulation was almost abolished at PaCO2 levels of greater than 50 mm Hg. The degree of hemodilution neither affected the CO2 response nor impaired CBF autoregulation, although, as would be expected, it influenced CBF: In 33 women CBF was 55 ml/100 g/min at an Htc of 24%, as compared with 42 ml/100 g/min in 35 men (Htc = 28%). High PaO2 was a vasoconstrictor, the autoregulatory plateau being narrowed. The lower limit of autoregulation was shifted to a higher pressure when PaO2 was low.

Tissue-blood partition coefficient for xenon: temperature and hematocrit dependence.

ARTICLESTissue-blood partition coefficient for xenon: temperature and hematocrit dependenceR. Y. Chen, F. C. Fan, S. Kim, K. M. Jan, S. Usami, and S. ChienR. Y. Chen, F. C. Fan, S. Kim, K. M. Jan, S. Usami, and S. ChienPublished Online:01 Aug 1980https://doi.org/10.1152/jappl.1980.49.2.178MoreSectionsPDF (2 MB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInEmailWeChat Previous Back to Top Next Download PDF FiguresReferencesRelatedInformationCited ByUsing hyperpolarized 129Xe gas-exchange MRI to model the regional airspace, membrane, and capillary contributions to diffusing capacityZiyi Wang, Leith Rankine, Elianna. A. Bier, David Mummy, Junlan Lu, Alex Church, Robert M. Tighe, Aparna Swaminathan, Yuh-Chin T. Huang, Loretta G. Que, Joseph G. Mammarappallil, Sudarshan Rajagopal, and Bastiaan Driehuys11 May 2021 | Journal of Applied Physiology, Vol. 130, No. 5Safety, hemodynamic effects, and detection of acute xenon inhalation: rationale for banning xenon from sportJustin S. Lawley,* Hannes Gatterer,* Katrin A. Dias, Erin J. Howden, Satyam Sarma, William K. Cornwell, Christopher M. Hearon, Mitchel Samels, Braden Everding, Richard K. Bruick, Max Hendrix, Thomas Piper, Mario Thevis, and Benjamin D. Levine26 November 2019 | Journal of Applied Physiology, Vol. 127, No. 6Removal of hyperpolarized 129 Xe gas-phase contamination in spectroscopic imaging of the lungs12 June 2018 | Magnetic Resonance in Medicine, Vol. 262The Physics of Hyperpolarized Gas MRIInert gas clearance from tissue by co-currently and counter-currently arranged microvesselsY. Lu, C. C. Michel, and W. Wang1 August 2012 | Journal of Applied Physiology, Vol. 113, No. 3Laser-Polarized Xenon Nuclear Magnetic Resonance, a Potential Tool for Brain Perfusion Imaging: Measurement of the Xenon T1In VivoEffects of hyperthermia on cerebral blood flow and metabolism during prolonged exercise in humansLars Nybo, Kirsten Møller, Stefanos Volianitis, Bodil Nielsen, and Niels H. Secher1 July 2002 | Journal of Applied Physiology, Vol. 93, No. 1Hyperpolarized 129Xe MRI Using Gas-Filled LiposomesAcademic Radiology, Vol. 9, No. 1Unchanged Cerebral Blood Flow and Oxidative Metabolism after Acclimatization to High Altitude31 August 2016 | Journal of Cerebral Blood Flow & Metabolism, Vol. 22, No. 1Determination of regional ventilation and perfusion in the lung using xenon and computed tomographyThomas C. Kreck, Melissa A. Krueger, William A. Altemeier, Scott E. Sinclair, H. Thomas Robertson, Erin D. Shade, Jacob Hildebrandt, Wayne J. E. Lamm, David A. Frazer, Nayak L. Polissar, and Michael P. Hlastala1 October 2001 | Journal of Applied Physiology, Vol. 91, No. 4Transcranial doppler sonography and internal jugular bulb saturation during hyperventilation in patients with fulminant hepatic failureLiver Transplantation, Vol. 7, No. 4CEREBROVASCULAR METABOLIC AUTOREGULATION IS IMPAIRED DURING LIVER TRANSPLANTATION1Transplantation, Vol. 68, No. 10Pharmacologic Electroencephalographic Suppression During Cardiopulmonary BypassAnesthesia & Analgesia, Vol. 86, No. 2Isolated Cerebral Hypothermia by Single Carotid Artery Perfusion of Extracorporeally Cooled Blood in BaboonsNeurosurgery, Vol. 39, No. 3Phenylephrine Increases Cerebral Blood Flow during Low-flow Hypothermic Cardiopulmonary Bypass in BaboonsAnesthesiology, Vol. 85, No. 2Cerebral Physiologic Effects of Burst Suppression Doses of Propofol During Nonpulsatile Cardiopulmonary BypassAnesthesia & Analgesia, Vol. 81, No. 3β-adrenergic stimulation and abdominal subcutaneous fat blood flow in lean, obese, and reduced-obese subjectsMetabolism, Vol. 44, No. 2Periprandial regulation of lipid metabolism in insulin-treated diabetes mellitusMetabolism, Vol. 42, No. 4The assessment of cerebral function during paediatric cardiopulmonary bypass30 June 2016 | Perfusion, Vol. 8, No. 1Effects of muscle temperature on the V̇O2 kinetics at the onset of exercise in manRespiration Physiology, Vol. 88, No. 3Adipose tissue metabolism in obesity: Lipase action in vivo before and after a mixed mealMetabolism, Vol. 41, No. 3Validation of 133 Xe Clearance as a Cerebral Blood Flow Measurement Technique during Cardiopulmonary Bypass28 June 2016 | Journal of Cerebral Blood Flow & Metabolism, Vol. 12, No. 1Cerebral blood flow during cardiopulmonary bypass in a patient with occlusive cerebrovascular diseaseJournal of Cardiothoracic Anesthesia, Vol. 3, No. 1Xenon handling in the liver: red cell capacity effect.Circulation Research, Vol. 63, No. 4Skin blood flow from gas transport: Helium xenon and laser Doppler comparedMicrovascular Research, Vol. 35, No. 2Brain Luxury Perfusion during Cardiopulmonary Bypass in Humans. A Study of the Cerebral Blood Flow Response to Changes in CO 2 , O 2 , and Blood Pressure29 June 2016 | Journal of Cerebral Blood Flow & Metabolism, Vol. 6, No. 3Measurement of blood flow in the dental pulp of dogs with the 133xenon washout methodArchives of Oral Biology, Vol. 28, No. 6Local Cerebral Blood Flow Values as Estimated with Diffusible Tracers: Validity of Assumptions in Normal and Ischemic Tissue29 June 2016 | Journal of Cerebral Blood Flow & Metabolism, Vol. 1, No. 4 More from this issue > Volume 49Issue 2August 1980Pages 178-183 Copyright & PermissionsCopyright © 1980 the American Physiological Societyhttps://doi.org/10.1152/jappl.1980.49.2.178PubMed7400000History Published online 1 August 1980 Published in print 1 August 1980 Metrics

Closed chest cardiopulmonary bypass in deep hypothermia: The use of the pulmonary vasculature as left heart vent

In the in situ arrested perfused heart left ventricular overdistention does not invariably occur. This has been shown to be the consequence of pulmonary valvular insufficiency permitting decompression by means of reverse flow from the left atrium through the pulmonary capillary bed to the right atrium. The clinical successes of closed-chest cardiopulmonary bypass in humans could in part be explained on this basis. A percutaneous method for rendering the pulmonary valve open was devised. The variations and limitations of extracorporeal circulation in closed-chest hypothermic dogs was evaluated in reference to left atrial pressure. The studies included the role of perfusion pressure and the effects of vasoactive drugs.