Journal of Surgical Research
Volume 146, Issue 1 , Pages 57-65 , 1 May 2008

Methylprednisolone Fails to Preserve Pulmonary Surfactant and Blood–Air Barrier Integrity in a Porcine Cardiopulmonary Bypass Model

  • Christian Mühlfeld, M.D.

      Affiliations

    • Department of Anatomy, Division of Electron Microscopy, University of Göttingen, Göttingen, Germany
    • Institute of Anatomy, Division of Histology, University of Bern, Bern, Switzerland
    • These authors contributed equally to this work.
    • Corresponding Author InformationTo whom correspondence and reprint requests should be addressed at University of Berne, Institute of Anatomy, Division of Histology, Baltzerstrasse 2, CH-3000 Bern 9, Switzerland.
    • ,
  • Oliver J. Liakopoulos, M.D.

      Affiliations

    • Department of Thoracic and Cardiovascular Surgery, University of Göttingen, Göttingen, Germany
    • These authors contributed equally to this work.
    • ,
  • Inga-Marie Schaefer, B.M.

      Affiliations

    • Department of Anatomy, Division of Electron Microscopy, University of Göttingen, Göttingen, Germany
    • ,
  • Friedrich A. Schöndube, M.D.

      Affiliations

    • Department of Thoracic and Cardiovascular Surgery, University of Göttingen, Göttingen, Germany
    • ,
  • Joachim Richter, M.D.

      Affiliations

    • Department of Anatomy, Division of Electron Microscopy, University of Göttingen, Göttingen, Germany
    • ,
  • Hilmar Dörge, M.D.

      Affiliations

    • Department of Thoracic and Cardiovascular Surgery, University of Göttingen, Göttingen, Germany

Received 18 January 2007

References 

  1. Asimakopoulos G. The inflammatory response to CPB: The role of leukocyte filtration. Perfusion. 2002;17:7
  2. Ng CSH, Wan S, Yim APC, et al. Pulmonary dysfunction after cardiac surgery. Chest. 2002;121:1269
  3. Massoudy P, Zahler S, Becker BF, et al. Evidence for inflammatory responses of the lungs during coronary artery bypass grafting with cardiopulmonary bypass. Chest. 2001;119:31
  4. Rinder C. Cellular inflammatory response and clinical outcome in cardiac surgery. Curr Opin Anaesthesiol. 2006;19:65
  5. Ng CSH, Wan S, Arifi AA, et al. Inflammatory response to pulmonary ischemia-reperfusion injury. Surg Today. 2006;36:205
  6. Liebold A, Keyl C, Birnbaum DE. The heart produces but the lungs consume proinflammatory cytokines following cardiopulmonary bypass. Eur J Cardiothorac Surg. 1999;15:340
  7. Wan S, DeSmet J-M, Barvais L, et al. Myocardium is a major source of proinflammatory cytokines in patients undergoing cardiopulmonary bypass. J Thorac Cardiovasc Surg. 1996;112:806
  8. Qing M, Vazquez-Jimenez JF, Klosterhalfen B, et al. Influence of temperature during cardiopulmonary bypass on leukocyte activation, cytokine balance, and post-operative organ damage. Shock. 2001;15:372
  9. Wąsowicz M, Sobczyński P, Biczysko W, et al. Ultrastructural changes in the lung alveoli after cardiac surgical operations with the use of cardiopulmonary bypass (CPB). Pol J Pathol. 1999;50:189
  10. Wąsowicz M, Sobczyński P, Drwila R, et al. Air-blood barrier injury during cardiac operations with the use of cardiopulmonary bypass (CPB) (An old story?). Scand Cardiovasc J. 2003;37:216
  11. Anyanwu E, Dittrich H, Gieseking R, et al. Ultrastructural changes in the human lung following cardiopulmonary bypass. Basic Res Cardiol. 1982;77:309
  12. Friedrich B, Schmidt R, Reiss I, et al. Changes in biochemical and biophysical surfactant properties with cardiopulmonary bypass in children. Crit Care Med. 2003;31:284
  13. Griese M, Wilnhammer C, Jansen S, et al. Cardiopulmonary bypass reduces pulmonary surfactant activity in infants. J Thorac Cardiovasc Surg. 1999;118:237
  14. McGowan FX, Ikegami M, del Nido PJ, et al. Cardiopulmonary bypass significantly reduces surfactant activity in children. J Thorac Cardiovasc Surg. 1993;106:968
  15. Gross NJ. Extracellular metabolism of pulmonary surfactant: The role of a new serine protease. Annu Rev Physiol. 1995;57:135
  16. Gross NJ, Kellam M, Young J, et al. Separation of alveolar surfactant into subtypes. Am J Respir Crit Care Med. 2000;162:617
  17. Ochs M, Schüttler M, Stichtenoth G, et al. Morphological alterations of exogenous surfactant inhibited by meconium can be prevented by dextran. Respir Res. 2006;7:86
  18. Siflinger-Birnboim A, Johnson A. Protein kinase C modulates pulmonary endothelial permeability: A paradigm for acute lung injury. Am J Physiol Lung Cell Mol Physiol. 2003;284:L435
  19. Carroll JL, McCoy DM, McGowan SE, et al. Pulmonary-specific expression of tumor necrosis factor-α alters surfactant lipid metabolism. Am J Physiol Lung Cell Mol Physiol. 2002;282:L735
  20. Phang PT, Keough KMW. Inhibition of pulmonary surfactant by plasma from normal adults and from patients having cardiopulmonary bypass. J Thorac Cardiovasc Surg. 1986;91:248
  21. Schmiedl A, Krug N, Hohlfeld JM. Influence of plasma and inflammatory proteins on the ultrastructure of exogenous surfactant. J Electron Microsc. 2004;53:407
  22. Chaney MA. Corticosteroids and cardiopulmonary bypass. Chest. 2002;121:921
  23. Tassani P. Corticosteroids during operations using cardiopulmonary bypass. J Clin Anesth. 2000;12:242
  24. Liakopoulos OJ, Mühlfeld C, Koscinsky M, et al. Progredient loss of myocardial contractile function despite unimpaired coronary flow after cardiac surgery. Basic Res Cardiol. 2005;100:75
  25. Liakopoulos OJ, Teucher N, Mühlfeld C, et al. Prevention of TNF-α-associated myocardial dysfunction resulting from cardiopulmonary bypass and cardioplegic arrest by glucocorticoid treatment. Eur J Cardiothorac Surg. 2006;30:263
  26. Tassani P, Richter JA, Barankay A, et al. Does high-dose methylprednisolone in aprotinin-treated patients attenuate the systemic inflammatory response during coronary artery bypass grafting procedures?. J Cardiothorac Vasc Anesth. 1999;13:165
  27. Weibel ER. Stereological Methods. Vol. 1: Practical Methods for Biological Morphometry. London: Academic Press; 1979;
  28. Ochs M, Nenadic I, Fehrenbach A, et al. Ultrastructural alterations in intraalveolar surfactant subtypes after experimental ischemia and reperfusion. Am J Respir Crit Care Med. 1999;160:718
  29. Schmiedl A, Hoymann H-G, Ochs M, et al. Increase of inactive intra-alveolar surfactant subtypes in lungs of asthmatic Brown Norway rats. Virchows Arch. 2003;442:56
  30. Vedel-Jensen EB, Gundersen HJG. The rotator. J Microsc. 1993;171:35
  31. Howard CV, Reed MG. Unbiased Stereology (Three-Dimensional Measurement in Microscopy). Oxford: BIOS; 1998;
  32. Velazquez M, Weibel ER, Kuhn C, et al. PET. evaluation of pulmonary vascular permeability: a structure-function correlation. J Appl Physiol. 1991;70:2206
  33. Jobe AH, Ikegami M. Surfactant and acute lung injury. Proc Assoc Am Physicians. 1998;110:489
  34. Kotani N, Hashimoto H, Sessler DI, et al. Cardiopulmonary bypass produces greater pulmonary than systemic proinflammatory cytokines. Anesth Analg. 2000;90:1039
  35. Brix-Christensen V, Vestergaard C, Chew M, et al. Plasma cytokines do not reflect expression of pro- and anti-inflammatory cytokine mRNA at organ level after cardiopulmonary bypass in pigs. Acta Anaesthesiol Scand. 2003;47:525
  36. Goldblum SE, Hennig B, Jay M, et al. Tumor necrosis factor α-induced pulmonary vascular endothelial injury. Infect Immunol. 1989;57:1218
  37. Carney DE, Lutz CJ, Picone AL, et al. Soluble tumor necrosis factor receptor prevents post-pump syndrome. J Surg Res. 1999;83:113
  38. Tonz M, Mihaljevic T, von Segesser LK, et al. Acute lung injury during cardiopulmonary bypass (Are the neutrophils responsible?). Chest. 1995;108:1551
  39. Asimakopoulos G, Smith PL, Ratnatunga CP, et al. Lung injury and acute respiratory distress syndrome after cardiopulmonary bypass. Ann Thorac Surg. 1999;68:1107
  40. Liakopoulos OJ, Schmitto JD, Kazmaier S, et al. Cardiopulmonary and systemic effects of methylprednisolone in patients undergoing cardiac surgery. Ann Thorac Surg. 2007;(in press)
  41. Chaney MA, Nikolov MP, Blakeman BP, et al. Hemodynamic effects of methylprednisolone in patients undergoing cardiac operation and early extubation. Ann Thorac Surg. 1999;67:1006
  42. Fillinger MP, Rassias AJ, Guyre PM, et al. Glucocorticoid effects on the inflammatory and clinical responses to cardiac surgery. J Cardiothorac Vasc Anesth. 2002;16:163
  43. Chaney MA, Durazo-Arvizu RA, Nikolov MP, et al. Methylprednisolone does not benefit patients undergoing coronary artery bypass grafting and early tracheal extubation. J Thorac Cardiovasc Surg. 2001;121:561
  44. Morariu AM, Loef BG, Aarts LPHJ, et al. Dexamethasone: Benefit and prejudice for patients undergoing on-pump coronary artery bypass grafting. Chest. 2005;128:2677
  45. Hill GE, Pohorecki R, Alonso A, et al. Aprotinin reduces interleukin-8 production and lung neutrophil accumulation after cardiopulmonary bypass. Anesth Analg. 1996;83:696

PII: S0022-4804(07)00180-1

doi: 10.1016/j.jss.2007.03.026

Journal of Surgical Research
Volume 146, Issue 1 , Pages 57-65 , 1 May 2008

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