AI Summary & Key Takeaways
AI InsightConclusion: A strategy of normothermic CPB seems to be as safe as hypothermic CPB and is associated with a reduced inflammatory response and offers a better outcome.
📌 3 Key Takeaways
Abstract
Objective: To evaluate the effects of perfusion temperature on inflammatory response, and outcome in patients undergoing open heart surgery. Methods: Forty nine patients were assigned to 2 groups, group I (n=24) normothermic cardiopulmonary bypass (CPB) and group II (n=25) hypother- mic CPB. Blood samples were collected preoperatively and postoperatively for interleukin-6 (IL6) and high sensitive CRP (hsCRP). Concerning the variables, there were no significant preoperative differences between the groups. Results: At the end of CPB, mean plasma levels of IL-6 was significantly lower in the normothermia group (Group 1: 34.0±14.9 vs. Group 2: 53.0±41. p<0.05). At postoperative 12h, IL6 concentrations were 25.2±9.2 in Group 1 and 34.0±21.2 in Group 2 (p>0.05). In 24 h, the IL-6 concentrations were 20.4±8.1 in Group 1 and 29.6±21.1 in Group 2 (p>0.05). High sensitive CRP levels were significantly higher at the end of CPB than the preoperative levels (Group 1: 16.1±3.4 vs. Group 2: 18.5±3.6, p<0.05). At postoperative 12 h and 24 h, hsCRP concentrations declined (Group 1: 12.8±2.6 vs. Group 2: 13.2±2.9 at 12h, p>0.05 and Group 1: 12.3±2.6 vs. Group 2: 14.2±2.8 at 24 h, p>0.05). Normothermic CPB resulted in a shorter CPB time; 63.1 ±19.1min. vs 82.0 ±19.2 min. (p <0.01) and the interval up to extubation was 8.9±2.5 h vs. 11.6±4.6 h (p<0.05). Blood loss was 633.1±390.4 ml vs. 981.8±438.0 ml (p<0.05) and use of blood was 2.7±0.7 packages vs. 4.2±0.5 packages (p<0.01) in Group 1 and Group 2 respectively, as well as the length of ICU stay 2.5±0.5 vs. 4.0±0.6 days, (p<0.01). Length of hospital stay was significantly shorter in the normothermic group 7.2±0.5 days vs. 8.0±0.6 days (p<0.01). Conclusion: A strategy of normothermic CPB seems to be as safe as hypothermic CPB and is associated with a reduced inflammatory response and offers a better outcome.
Özet
Amaç: Açık kalp cerrahisinde perfüzyon ısısının inflamatuar cevap ve sonuçlar üzerine etkilerinin araştırılması. Yöntemler: Toplam 49 hasta iki gruba bölünmüştür, Grup 1 (n=24) normotermik opere edilmiş,gurup 2 (n=25) hipotermik kardiyopulmoner bypass (KPB) altında opere edilmiştir. Preoperatif ve postoperatif dönemde interleukin-6 (IL6) ve high sensitive CRP (hsCRP) seviyeleri için kan örnekleri alınmıştır. Bulgular: Kardiyopulmoner bypassın sonunda IL-6 değerleri normotermik opere edilmiş grupta hipotermik gruba oranla belirgin olarak düşük bulun- muştur (Grup 1: 34.0±14.9-Grup 2: 53.0±41. p 0.05). Yirmi dördüncü saatte IL-6 seviyeleri Grup 1: 20.4±8.1, Grup 2: 29.6±21.1 olarak bulunmuştur (p>0.05). High sensitive CRP değerleri Grup 1: 16.1±3.4, Grup 2: 18.5±3.6 (p 0.05 ve Grup 1: 12.3±2.6-Grup 2: 14.2±2.8 24.saat, p>0.05). Grup 1de KPB ve extubasyon süreleri Grup 2ye göre belirgin kısadır (63.1±19.1 dakika- 82.0 ±19.2 min. (p <0.01)) ve (8.9±2.5 saat - 11.6±4.6 saat (p<0.05). Grup 1 ve Grup 2 karşılaştırıldığında drenaj miktarı 633.1±390.4 mL - 981.8±438.0 mL (p<0.05), kan kullanımı 2.7±0.7 torba-4.2±0.5 torba (p<0.01), yoğun bakım süresi 2.5±0.5-4.0±0.6 gün, (p<0.01) bulunmuştur. Tüm bu sonuçlar normotermik grubun hastane yatış süresini olumlu etkilemiştir 7.2±0.5 gün-8.0±0.6 gün (p<0.01). Sonuç: Normotermik KPB stratejisi en az hipotermik KPB kadar güvenli olmasının yanı sıra inflamatuar cevabı azaltmış ve daha iyi sonuçlar vermiştir.