Endotoxemia related to cardiopulmonary bypass is associated with increased risk of infection after cardiac surgery: a prospective observational study

详细信息    查看全文

• 作者：David J Klein (1)
  Francoise Briet (2)
  Rosane Nisenbaum (3)
  Alexander D Romaschin (4)
  C David Mazer (5)
  
• 刊名：Critical Care
• 出版年：2011
• 出版时间：December 2011
• 年：2011
• 卷：15
• 期：1
• 全文大小：
• 作者单位：David J Klein (1)
  Francoise Briet (2)
  Rosane Nisenbaum (3)
  Alexander D Romaschin (4)
  C David Mazer (5)
  
  1. Department of Critical Care and the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, 4-054C Queen Wing, 30 Bond Street, Toronto, ON M5B 1W8, Canada
  2. Department of Anesthesia, St. Michael’s Hospital, University of Toronto, 1-028e Shuter Wing, 30 Bond Street, Toronto, ON M5B 1W8, Canada
  3. Centre for Research in Inner City Health in The Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Dalla Lana School of Public Health, University of Toronto, 209 Victoria Street, Room 3-25B, Toronto, ON M5B 1W8, Canada
  4. Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Department of Laboratory Medicine and Pathobiology, University of Toronto, Room 2-006 Cardinal Carter Wing, 30 Bond Street, Toronto, ON M5B 1W8, Canada
  5. Department of Anesthesia and the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Room 1-028e, Shuter Wing, 30 Bond Street, Toronto, ON M5B 1W8, Canada
  
• ISSN：1364-8535

文摘

Introduction Previous studies have documented a high frequency of endotoxemia associated with cardiopulmonary bypass (CPB). Endotoxemia may be responsible for some of the complications associated with cardiac surgery. The purpose of the study was to examine the prevalence of endotoxemia during cardiopulmonary bypass supported aortocoronary bypass grafting surgery (ACB) using a new assay, the Endotoxin Activity Assay (EAA), and explore the association between endotoxemia and post-operative infection. Methods The study was a single center prospective observational study measuring EAA during the perioperative period for elective ACB. Blood samples were drawn at induction of anesthesia (T1), immediately prior to release of the aortic cross-clamp (T2), and on the first post-operative morning (T3). The primary outcome was the prevalence of endotoxemia. Secondary outcomes assessed included infection rates, intensive care unit (ICU) and hospital length of stay. An EAA of < 0.40 units was interpreted as "low", 0.41 to 0.59 units as "intermediate", and ≥0.60 units as "high". Results A total of 57 patients were enrolled and 54 patients were analyzable. The mean EAA at T1 was 0.38 +/- 0.14, at T2 0.39 +/- 0.18, and at T3 0.33 +/- 0.18. At T2 only 13.5% (7/52) of patients had an EAA in the high range. There was a positive correlation between EAA and duration of surgery (P = 0.02). In patients with EAA ≥0.40 at T2, 26.1% (6/23) of patients developed post-operative infections compared to 3.5% (1/29) of those that had a normal EAA (P = 0.0354). Maximum EAA over the first 24 hours was also strongly correlated with risk of post-operative infection (P = 0.0276). Conclusions High levels of endotoxin occur less frequently during ACB than previously documented. However, endotoxemia is associated with a significantly increased risk of the development of post-operative infection. Measuring endotoxin levels during ACB may provide a mechanism to identify and target a high risk patient population.