The impact of the pro‐ and anti‐inflammatory immune response on ventilation time after cardiac surgery

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Abstract
Background Cardiac surgery using cardiopulmonary bypass (CPB) may induce a systemic inflammatory response syndrome (SIRS), which is associated with an increased risk of postoperative morbidity and mortality. The intention of this pilot study was to investigate the influence of the pro‐ and anti‐inflammatory cytokine responses as well as of released adhesion molecules and endotoxin on the time requirements for assisted postoperative respiration following CPB surgery. Methods One hundred consecutive patients undergoing elective coronary artery bypass grafting (CABG) using CPB were prospectively investigated. Blood levels of cytokines, adhesion molecules, and endotoxins were serially measured at four time points perioperatively. Results All patients survived the observation period. Eighty‐five patients were uneventful (group 1), whereas 15 patients required prolonged ventilation (34.8 ± 9.2 h; group 2). All patients developed a pro‐inflammatory and a compensatory anti‐inflammatory cytokine response. An endotoxin liberation was found in parallel. The prediction of prolonged respirator dependence may be possible at completion of surgery using a combined data pattern analysis, including interleukin (IL)‐6, IL‐8, IL‐4, endotoxins, vascular cell adhesion molecule (VCAM)‐1, age, and cross clamp (x‐clamp) time. Using arbitrary cutoff points improved sensitivity (0.92), specificity (0.90), positive prediction (0.87), and negative prediction (0.85) (all P < 0.02), and the ODD ratio (2.1) was found. Conclusions Cardiac surgery and CPB induces both a pro‐ and anti‐inflammatory immune response. The use of a data pattern instead of several individual parameters seems advantageous for individualized predictions on postoperative recovery in CPB surgery. Cytometry Part B (Clin. Cytometry) 53B:70–74, 2003.