Postperfusion lung syndrome: Respiratory mechanics, respiratory indices and biomarkers

Association between inflammatory biomarkers and acute respiratory distress syndrome or acute lung injury risk : A systematic review and meta-analysis

Background

The relationship between acute respiratory distress syndrome (ARDS)/acute lung injury (ALI) and levels of certain inflammatory factors remains controversial. The purpose of this meta-analysis was to summarize the available studies evaluating the association between levels of inflammatory factors and ARDS/ALI incidence.

Methods

We searched the PubMed, EmBase, and Cochrane databases for studies published up to July 2017. For each inflammatory factor, a random effects model was employed to pool results from different studies.

Results

We identified 63 studies that included 6243 patients in our meta-analysis. Overall, the results indicated that the levels of angiopoietin (ANG)-2 (standard mean difference, SMD: 1.34; P < 0.001), interleukin (IL)-1β (SMD: 0.92; P = 0.012), IL‑6 (SMD: 0.66; P = 0.005), and tumor necrosis factor (TNF)-α (SMD: 0.98; P = 0.001) were significantly higher in patients with ARDS/ALI than in unaffected individuals. No significant differences were observed between patients with ARDS/ALI and unaffected individuals in terms of the levels of IL‑8 (SMD: 0.61; P = 0.159), IL-10 (SMD: 1.10; P = 0.231), and plasminogen activator inhibitor (PAI)-1 (SMD: 0.70; P = 0.060).

Conclusions

ARDS/ALI is associated with a significantly elevated levels of ANG‑2, IL-1β, IL‑6, and TNF‑α, but not with IL‑8, IL-10, and PAI‑1 levels.

Supplementary Information

The online version of this article (10.1007/s00508-021-01971-3) contains supplementary material, which is available to authorized users.

The Second Gaddum Lecture: its origins and outcomes

Fifty years ago, the BJP published the Second Gaddum Lecture, given by John Vane to the British Pharmacological Society. This article assesses the origins of the experiments described in the Lecture, linking them directly to Gaddum's use of bioassay, a defining feature of pharmacology. The outcomes of those experiments are also assessed, tracking those results that have survived the past five decades. Two of the major advances in cardiovascular medicine, the ACE inhibitors, as anti-hypertensives, and low-dose aspirin, to prevent thrombosis were initiated by the work in this Lecture. Physiologically significant outcomes include a new non-respiratory function of the lung, based on the metabolism of endogenous vasoactive substrates in the pulmonary circulation and the recognition of the endothelium as a highly interactive component of blood vessels. The present state of the art in pharmacology, physiology and medicine owes much to the work described in the Second Gaddum Lecture.

Effect of ulinastatin on interleukins and pulmonary function in bypass patients: a meta-analysis of randomized controlled trials

BACKGROUND

Our aim was to evaluate the effect of urinary trypsin inhibitors (UTI) on interleukin, tumor necrosis factor-α (TNF-α), and polymorphonuclear neutrophil elastase (PMNE) levels as well as on pulmonary function in patients undergoing cardiopulmonary bypass.

MATERIALS AND METHODS

We searched the following databases for relevant studies: PubMed, Medline (Ovid SP), Cochrane Library, Wanfang Data, China Biology Medicine Database, Chinese Periodical Database, China Knowledge Resource Integrated Database, and Chinese Clinical Trial Registry. Two investigators independently collected the data and assessed the quality of each study. RevMan 5.3 was used for the meta-analysis.

RESULTS

In total, 15 randomized controlled trials (646 patients) met the inclusion criteria. There was a significant decrease in TNF-α, interleukin-6 (IL-6), IL-8, and PMNE levels at 6 h and 24 h after UTI treatment and an increase in IL-10 levels; additionally, there was a decrease in respiratory index and an improvement in the oxygenation index. Nevertheless, UTI treatment did not affect the length of intensive care unit stay, alveolar-arterial oxygen partial pressure difference, adverse lung events, or hospital mortality. Because of the high heterogeneity of the included trials, the results should be assessed carefully.

CONCLUSION

UTI treatment can suppress proinflammatory cytokine elevation and upregulate the release of anti-inflammatory mediators, thereby reducing pulmonary injury and improving pulmonary function after cardiopulmonary bypass.

The synergistic effect of propofol and ulinastatin suppressed the viability of the human lung adenocarcinoma epithelial A549 cell line

Ulinastatin and propofol (PPF) are recognized for their anticancer properties. The aim of the present study was to evaluate the synergistic antitumor effect of PPF followed by ulinastatin against A549 cells. In MTT assays, PPF (10, 20 and 30 µM) followed by 200 U/ml ulinastatin was more effective at inhibiting A549 cell viability compared with PPF (10, 20 and 30 µM) or 200 U/ml ulinastatin. PPF (10, 20 and 30 µM) followed by 200 U/ml ulinastatin treatments synergistically increased the number of S cells and synergistically reduced the number of G2/M cells associated with PPF stimulation in a dose-dependent manner. Western blot analysis demonstrated that the antitumor effect of PPF followed by 200 U/ml ulinastatin treatments were associated with the downregulated expression of extracellular signal-regulated kinase 1 and 2 phosphorylation (p-ERK1/2) and matrix metalloproteinases 2 (MMP-2). In conclusion, these data demonstrated that PPF (20 and 30 µM) followed by 200 U/ml ulinastatin treatments synergistically stimulated a significant proportion of A549 cells in S phase. Furthermore, the combination synergistically reduced a significant proportion of A549 cells in G2/M phase and synergistically suppressed the viability of A549 cells, which was possibly related regulation of the expression of p-ERK1/2 and MMP-2 in A549 cells.

High-dose ulinastatin improves postoperative oxygenation in patients undergoing aortic valve surgery with cardiopulmonary bypass: A retrospective study

Objective

To determine whether pre-treatment with high-dose ulinastatin provides enhanced postoperative oxygenation in patients who have undergone aortic valve surgery with moderate hypothermic cardiopulmonary bypass (CPB).

Methods

Patients who underwent aortic valve surgery with moderate hypothermic CPB were retrospectively evaluated. In total, 94 of 146 patients were included. The patients were classified into one of two groups: patients in whom ulinastatin (10,000 U/kg followed by 5,000 U/kg/h) was administered during CPB (Group U, n = 38) and patients in whom ulinastatin was not administered (Group C, n = 56). The PaO₂/FiO₂ ratio was calculated at the following time points: before CPB (pre-CPB), 2 h after weaning from CPB (post-CPB), and 6 h after arrival to the intensive care unit (ICU-6). The incidence of a low PaO₂/FiO₂ ratio was also compared among the time points.

Results

Group U showed a significantly higher PaO₂/FiO₂ ratio (F(4, 89.0) = 657.339) and a lower incidence of lung injury (PaO₂/FiO₂ ratio < 300) than Group C at the post-CPB and ICU-6 time points.

Conclusion

High-dose ulinastatin improved pulmonary oxygenation after CPB and in the early stages of the ICU stay in patients undergoing aortic valve surgery with CPB.

Postperfusion lung syndrome and related sequelae

Postperfusion lung syndrome is a rare but sometimes lethal complication secondary to cardiopulmonary bypass. It often leads to multiorgan failure and mixed acid-base disturbances, thus making a refractory condition. A 69-year-old female, undergoing a successful cardiac lipoma resection under cardiopulmonary bypass, unfortunately developed postperfusion lung syndrome with associated multiorgan failure and triple acid-base disturbances (TABDs). Her condition deteriorated rapidly on postoperative day three and became moribund. This article reports a rare association following a surgical resection of cardiac lipoma, complicated with postperfusion lung syndrome and high-anion-gap and hyperchloride TABDs. It is recommended that proper positive end-expiratory pressure (PEEP) (5-10 cmH2O) with low tidal volume (6 mL/kg) be applied in order to minimize the compromise to cardiac function of cardiac surgical patients.