Cardiopulmonary bypass in man: role of the intestine in a self-limiting inflammatory response with demonstrable bacterial translocation

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Original article: cardiovascular

Cardiopulmonary bypass in man: role of the intestine in a self-limiting inflammatory response with demonstrable bacterial translocation

Marco Rossi, MD^a^*, Gabriele Sganga, MD^b, Marinella Mazzone, MD^c, Venanzio Valenza, MD^f, Sergio Guarneri, MD^a, Grazia Portale, MD^c, Luigi Carbone, MD^c, Lucia Gatta, PhD^d, Claudio Pioli, PhD^d, Maurizio Sanguinetti, MD^e, Massimo Montalto, MD^c, Franco Glieca, MD^g, Giovanni Fadda, MD^e, Rocco Schiavello, MD^a, Nicolò G. Silveri, MD^c

^a Department of Anesthesia, Unit of Cardiac Anesthesia, Rome, Italy
^b Department of Surgery, Rome, Italy
^c Department of Medicine, Rome, Italy
^d ENEA, Section of Toxicology and Biomedicine, Rome, Italy
^e Department of Microbiology, Rome, Italy
^f Department of Nuclear Medicine, Rome, Italy
^g Department of Cardiac Surgery, Università Cattolica del Sacro Cuore, Policlinico "A. Gemelli," Rome, Italy

Accepted for publication August 1, 2003.

^* Address reprint requests to Dr Rossi, Department of Anesthesia, Università Cattolica del S. Cuore Policlinico A. Gemelli, largo A. Gemelli n.8, 00168 Rome, Italy
e-mail: cardioanucsc{at}rm.unicatt.it

BACKGROUND: Cardiopulmonary bypass provokes a systemic inflammatory reactionthat, in 1% to 2% of all cases, leads to multiorgan disfunction.The aim of this study was to evaluate the possible role of theintestine in the pathogenesis and development of this reaction.

METHODS: Eleven selected patients scheduled for elective coronary arterybypass graft surgery were enrolled in a open, prospective clinicalstudy. Gastric tonometry, chromium-labeled test and double sugarintestinal absorption tests, polymerase chain reaction microbialDNA test, and measurement of cytokines and transcriptional factor(nuclear factor ${kappa}$ B) activation were performed.

RESULTS: During the postoperative period, gastric pH remained stable(range,7.2 to 7.3). The partial pressure for carbon dioxidegradient between the gastric mucosa and arterial blood increasedsignificantly (from 1 to 23 mm Hg), peaking in the sixth postoperativehour. Interleukin 6 increased significantly over basal levels,peaking 3 hours after cardiopulmonary bypass (96.3 versus 24pg/mL). Nuclear factor ${kappa}$ B never reached levels higher than thoseobserved after lipopolysaccharide stimulation. Escherichia colitranslocation was documented in 10 patients: in eight casesfrom removal of aortic cross-clamps and in two cases from thefirst postoperative hour. With respect to basal value (6.4%),the urine collection revealed a significant increase in excretionof the radioisotope during the first 24 hours after surgery(39.1%), although there were no significant variations withthe double sugar test.

CONCLUSIONS: The results obtained showed a correlation between the damageof the gastrointestinal mucosa, subsequent increased permeability,E coli bacteremia, and the activation of a self-limited inflammatoryresponse in the absence of significant macrocirculatory changesand postoperative complications.

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