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The Annals of Thoracic Surgery, Vol 56, 1499-1502, Copyright © 1993 by The Society of Thoracic Surgeons
AB Millar, L Armstrong, J van der Linden, N Moat, R Ekroth, J Westwick, M Scallan and C Lincoln
Multiorgan dysfunction still occurs after cardiopulmonary bypass and
remains a major cause of morbidity and mortality, especially in the
pediatric age group. This is consequent upon the so-called systemic
inflammatory response to bypass with an increase in inflammatory mediators.
Hemofiltration may be able to attenuate the effects of this response by
elimination of some or all of these mediators. We undertook a prospective,
randomized study to investigate the effect of hemofiltration on plasma
levels of the cytokines tumor necrosis factor alpha, interleukin-8, and
interleukin 6 in 18 infants and children undergoing deep hypothermic
bypass. Serial plasma samples were taken before, during, and after bypass.
Assay of the plasma samples revealed presence of the cytokines in a number
of subjects in both groups, in some cases before operation. There were
significant reductions in levels of tumor necrosis factor after
hemofiltration, with no reduction noted in the group not undergoing
hemofiltration. A similar difference (p < 0.05) was detected in the
levels of interleukin-6 between the two groups after bypass, although this
was largely due to changes in 2 subjects. Interleukin-8 was detected in a
small number of subjects insufficient for statistical analysis, but with
higher values in the group undergoing hemofiltration. We conclude that
hemofiltration has the potential to remove cytokines from the circulation,
with consequent beneficial effects.
ARTICLES
Cytokine production and hemofiltration in children undergoing cardiopulmonary bypass
School of Postgraduate Medicine, University of Bath, England.
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