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J Thorac Cardiovasc Surg 1994;107:1193-1202
© 1994 Mosby, Inc.
CARDIOPULMONARY BYPASS, |
Saskatoon, Saskatchewan, Canada
Supported by a grant from the Canadian Heart and Stroke Foundation.
Received for publication May 19, 1993. Accepted for publication Nov. 8, 1993. Address for reprints: David Johnson, MD, Box 95, Royal University Hospital, Saskatoon, Saskatchewan, Canada S7N 4J9.
Abstract
A pulmonary injury of varying severity occurs routinely after cardiopulmonary bypass. We studied the pulmonary complications of partial cardiopulmonary bypass in four groups of dogs to better define the injury and to evaluate the efficacy of two interventions (addition of a leukocyte filter or cyclooxygenase inhibition) on preservation of systemic oxygenation. All animals received a standard anesthetic (pentobarbital, morphine, and vecuronium) and, after sternotomy, three groups of animals received 3 hours of partial cardiopulmonary bypass. The animals were randomized to receive partial bypass alone (n = 6), indomethacin and bypass (n = 5), or a leukocyte filter and bypass (n = 5). A fourth group (n = 5) did not receive bypass and served as a time control. We measured blood gases and also obtained histologic samples to assess the degree of lung injury. We found that bypass alone caused a significant reduction (p < 0.05) in arterial oxygen tension 1 hour after the conclusion of bypass (175 ± 53 mm Hg) compared with prebypass values (357 ± 41 mm Hg). Pretreatment with indomethacin ameliorated the decrease in arterial oxygen tension from prebypass to postbypass values (477 ± 50 mm Hg versus 339 ± 57 mm Hg, respectively). Similarly use of a leukocyte filter reduced the decline in arterial oxygen tension from prebypass to postbypass values (440 ± 71 mm Hg versus 311 ± 73 mm Hg, respectively). We believe that indomethacin ameliorates the decline in systemic oxygenation associated with bypass by augmentation of hypoxic pulmonary vasoconstriction and that the leukocyte filter acted to reduce pulmonary edema and thereby minimized intrapulmonary shunt. (J THORACCARDIOVASCSURG1994;107:1193-1202)
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