M. Griese, MD, C. Wilnhammer, MD, S. Jansen *, C. Rinker, MD

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Presentation transcript:

Cardiopulmonary bypass reduces pulmonary surfactant activity in infants M. Griese, MD, C. Wilnhammer, MD, S. Jansen *, C. Rinker, MD The Journal of Thoracic and Cardiovascular Surgery Volume 118, Issue 2, Pages 237-244 (August 1999) DOI: 10.1016/S0022-5223(99)70213-8 Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 1 Time course of the oxygenation index of the infants treated with CPB. For comparison, values from a control group of infants without lung disease are given. The data from infants 8 and 14, who had a nosocomial infection, were not included. Data are means ± SEM of n different subjects at each time point. *Indicates a difference from the control group (on day 0, P = .043; day 1, P = .023; day 2, P = .009; and day 3, P = .021). The Journal of Thoracic and Cardiovascular Surgery 1999 118, 237-244DOI: (10.1016/S0022-5223(99)70213-8) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 2 Total protein in the large-aggregate fraction (LA) (A) and small-aggregate fraction (SA) (B) of the lavage. C, Ratio of protein in small- and large-aggregate (SA/LA) fractions. Comparisons with the control group were made by t test. A, On day 0, P = .028; day 1, P = .002. B, On day 0, P = .033; day 1, P = .004; day 2, P = .001. C, On day 0, P = .032; day 1, P = .004; day 2, P = .008. Data are means ± SEM of n different subjects at each time point. The Journal of Thoracic and Cardiovascular Surgery 1999 118, 237-244DOI: (10.1016/S0022-5223(99)70213-8) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 3 Surfactant protein A (SP-A) (A and B ) and surfactant protein B (SP-B) (C and D ) in the large-aggregate fraction (LA) (upper panels) and small-aggregate fraction (SA) (lower panels) of the lavage. Comparisons with the control group were made by t test. A, On day 0, P = .045; day 1, P = .024. B, On day 0, P = .045; C, On day 0, P = .045; day 1, P = .024. D, On day 0, P = .028. Data are means ± SEM of n different subjects at each time point. The Journal of Thoracic and Cardiovascular Surgery 1999 118, 237-244DOI: (10.1016/S0022-5223(99)70213-8) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 4 Phospholipids in the large-aggregate fraction (LA) (A) and small-aggregate fraction (SA) (B) of the lavage. C, Ratio of phospholipids in small- and large-aggregate (SA/LA) fractions. Comparisons with the control group were made by t test. A, On day 0, P = .048. B, On day 0, P = .035. Data are means ± SEM of n different subjects at each time point. The Journal of Thoracic and Cardiovascular Surgery 1999 118, 237-244DOI: (10.1016/S0022-5223(99)70213-8) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 5 Surface tension of the large-aggregate fraction (LA) in the native state (A and C ) and of its lipid extract (B and D ). Minimal surface tension of the pulsating bubble (γmin ) (A and B ) and of the static bubble after adsorption (γads ) (C and D ). *Indicates a difference from the control group, assessed by t test. A, On day 1, P = .005; day 2, P = .001; day 3, P = .001. Data are means ± SEM of n different subjects at each time point. The Journal of Thoracic and Cardiovascular Surgery 1999 118, 237-244DOI: (10.1016/S0022-5223(99)70213-8) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 6 Inhibition of surfactant function by lavage constituents and serum. A natural bovine surfactant (phospholipid concentration 0.25 mg/mL) was mixed with the proteinaceous extract isolated from the large-aggregate fraction (LA) of the lavages of the control infants (filled triangles, n = 4) and of infants 2 to 4 days after CPB (filled squares, n = 11) at a protein concentration of 4 mg/mL. There were no differences between the 2 groups. For comparison, surfactant alone reduced surface tension to low values (open triangles, n = 7). In the presence of normal human serum (protein concentration 4 mg/mL), the surface activity of the natural bovine surfactant was similarly inhibited as in the presence of the material isolated from the lavages (open circles, n = 7). The Journal of Thoracic and Cardiovascular Surgery 1999 118, 237-244DOI: (10.1016/S0022-5223(99)70213-8) Copyright © 1999 Mosby, Inc. Terms and Conditions