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Metabolites 2018, 8(4), 54; https://doi.org/10.3390/metabo8040054

Lung Protection Strategies during Cardiopulmonary Bypass Affect the Composition of Bronchoalveolar Fluid and Lung Tissue in Cardiac Surgery Patients

1
Department of Anesthesia and Intensive Care Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark
2
Department of Cardiothoracic Anesthesia, Heart Centre, Rigshospitalet, 2100 Copenhagen, Denmark
3
Department of Forensic Medicine, University of Copenhagen, 2100 Copenhagen, Denmark
4
Department of Intensive Care, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark
5
Department of Anesthesiology, Hvidovre Hospital, University of Copenhagen, 2650 Hvidovre, Denmark
6
Department of Chemistry and Bioscience, Aalborg University, 9220 Aalborg, Denmark
7
Department of Clinical Medicine, School of Medicine and Health, Aalborg University, 9220 Aalborg, Denmark
*
Author to whom correspondence should be addressed.
Received: 28 June 2018 / Revised: 31 August 2018 / Accepted: 19 September 2018 / Published: 21 September 2018
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Abstract

Pulmonary dysfunction is among the most frequent complications to cardiac surgeries. Exposure of blood to the cardiopulmonary bypass (CPB) circuit with subsequent lung ischemia-reperfusion leads to the production of inflammatory mediators and increases in microvascular permeability. The study aimed to elucidate histological, cellular, and metabolite changes following two lung protective regimens during CPB with Histidine-Tryptophan-Ketoglutarate (HTK) enriched or warm oxygenated blood pulmonary perfusion compared to standard regimen with no pulmonary perfusion. A total of 90 patients undergoing CPB were randomized to receiving HTK, oxygenated blood or standard regimen. Of these, bronchoalveolar lavage fluid (BALF) and lung tissue biopsies were obtained before and after CPB from 47 and 25 patients, respectively. Histopathological scores, BALF cell counts and metabolite screening were assessed. Multivariate and univariate analyses were performed. Profound histological, cellular, and metabolic changes were identified in all patients after CPB. Histological and cellular changes were similar in the three groups; however, some metabolite profiles were different in the HTK patients. While all patients presented an increase in inflammatory cells, metabolic acidosis, protease activity and oxidative stress, HTK patients seemed to be protected against severe acidosis, excessive fatty acid oxidation, and inflammation during ischemia-reperfusion. Additional studies are needed to confirm these findings. View Full-Text
Keywords: ischemia-reperfusion injury; CPB; lung protection; HTK; oxygenated blood; lung biopsy; bronchoalveolar lavage; inflammation; metabolites; NMR ischemia-reperfusion injury; CPB; lung protection; HTK; oxygenated blood; lung biopsy; bronchoalveolar lavage; inflammation; metabolites; NMR
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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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Maltesen, R.G.; Buggeskov, K.B.; Andersen, C.B.; Plovsing, R.; Wimmer, R.; Ravn, H.B.; Rasmussen, B.S. Lung Protection Strategies during Cardiopulmonary Bypass Affect the Composition of Bronchoalveolar Fluid and Lung Tissue in Cardiac Surgery Patients. Metabolites 2018, 8, 54.

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