Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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Advances in Clinical and Experimental Medicine

2007, vol. 16, nr 5, September-October, p. 683–688

Publication type: review article

Language: English

Pulmonary Dysfunction and Acute Respiratory Distress Syndrome After Cardiopulmonary By−pass – Mechanisms and Prevention

Niewydolność układu oddechowego i ostry zespół niewydolności oddechowej po operacjach z zastosowaniem krążenia pozaustrojowego – mechanizmy powstawania i zapobieganie

Maciej Rachwalik1,, Marek Pelczar1,

1 Department of Cardiac Surgery, Silesian Piasts University of Medicine in Wrocław, Poland

Abstract

Postoperative lung injury is one of the most frequent complications of cardiac surgery. It mostly results from the use of cardiopulmonary bypass (CPB). However, recent comparative studies between conventional and off−pump coronary artery bypass grafting have indicated that CPB itself may not be the major contributor to the development of postoperative pulmonary dysfunction. Thus the pathophysiology of this complication is not clearly defined. This article summarizes the molecular and cellular mechanisms involved in pulmonary dysfunction after cardiopulmonary by−pass. The associated physiological, biochemical, and histological changes are reviewed with reference to the current understanding of the underlying mechanisms. Reports on the prevalence and mortality of acute respiratory distress syndrome after cardiac surgery are summarized. Therapeutic interventions and modifications which are helpful in the prevention of the described adverse results of cardiopulmonary bypass are also presented.

Streszczenie

Pooperacyjne uszkodzenie płuc jest częstym powikłaniem operacji kardiochirurgicznej i jest często związane z zastosowaniem krążenia pozaustrojowego (KPU). Kilka współczesnych badań porównujących konwencjonalną rewaskularyzację mięśnia sercowego i metodę rewaskularyzacji naczyń wieńcowych bez zastosowania maszyny płucoserce wskazało, że samo krążenie pozaustrojowe może nie być najważniejszym czynnikiem odpowiedzialnym za powstanie pooperacyjnego zaburzenia czynności oddechowej. Na tej podstawie można wnioskować, że patofizjologiczne mechanizmy odpowiedzialne za uszkodzenie układu oddechowego nie są ostatecznie wyjaśnione. Artykuł przedstawia molekularne i komórkowe mechanizmy odpowiedzialne za opisywane powikłanie. Przedstawiono zmiany z punktu widzenia fizjologii, biochemii i histologii. Szczególny nacisk położono na zespół ostrej niewydolności oddechowej. Zaprezentowano też metody stosowane w kardiochirurgii w celu zmniejszenia ryzyka wystąpienia opisanych powikłań.

Key words

cardiac surgery, cardiopulmonary bypass, cytokine, inflammatory response, lung injury, neutrophils, ventilation

Słowa kluczowe

kardiochirurgia, krążenie pozaustrojowe, cytokiny, odpowiedź zapalna, uszkodzenie płuc, neutrofile, wentylacja oddechowa

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