Adverse Effects of Cardio-Pulmonary Bypass “CPB” on Homeostasis
Ahmed Hussien Abd El-Fattah Sabry;
Abstract
Cardio-pulmonary bypass is one of the apparatuses used as an extracorporeal circuit. Extra corporeal Circulation is a procedure in which blood is taken from patient's circulation to have a process applied to it before it is returned to the circulation. The CPB is the machine that allows surgeons to operate on a nonmoving, bloodless heart. It allows the heart to be stopped so that it can be cut open and the blockage can be corrected.
With improvements in surgical techniques and extracorporeal oxygenation of CPB, the overall mortality for this procedure is low (1% to 4%). CPB is not benign and there are a number of associated problems. Excessive perioperative bleeding, systemic inflammatory response, neurocognitive complications, cardiovascular complications, pulmonary complications and renal complications can all complicate CPB.
Contact of blood to the foreign material of the extracorporeal circuit was held responsible for most of the bleeding complications. A number of other non-physiological events are introduced during CPB, including hemodilution, hypothermia, non-pulsatile blood flow, retransfusion of shed blood, and exclusion of the metabolic function of the lung can also contribute to the bleeding. Together, these events cause the massive and systemic activation of the patient’s defense mechanisms, with repercussions on nearly every end-organ system. Signs of this “whole body inflammatory reaction” can be observed in every postoperative patient.
Because the blood is being introduced to this foreign material, it is only natural that the body tries to protect itself. Therefore, SIRS often occurs after CPB as the body’s reaction to the new substance. It is characterized by the body producing at least two of the following characteristics: temperature >38°C or <36°C, heart rate >90 beats per minute, respiratory rate >20 breaths per minute or PaCO2 < 32 mmHg, or leukocytes >12,000. Another important finding after CPB is that the lungs are also oftentimes negatively affected. Up to 20% of patients after cardiac surgery with CPB need to be ventilated for more than 48 hours because of the pulmonary dysfunction.
With improvements in surgical techniques and extracorporeal oxygenation of CPB, the overall mortality for this procedure is low (1% to 4%). CPB is not benign and there are a number of associated problems. Excessive perioperative bleeding, systemic inflammatory response, neurocognitive complications, cardiovascular complications, pulmonary complications and renal complications can all complicate CPB.
Contact of blood to the foreign material of the extracorporeal circuit was held responsible for most of the bleeding complications. A number of other non-physiological events are introduced during CPB, including hemodilution, hypothermia, non-pulsatile blood flow, retransfusion of shed blood, and exclusion of the metabolic function of the lung can also contribute to the bleeding. Together, these events cause the massive and systemic activation of the patient’s defense mechanisms, with repercussions on nearly every end-organ system. Signs of this “whole body inflammatory reaction” can be observed in every postoperative patient.
Because the blood is being introduced to this foreign material, it is only natural that the body tries to protect itself. Therefore, SIRS often occurs after CPB as the body’s reaction to the new substance. It is characterized by the body producing at least two of the following characteristics: temperature >38°C or <36°C, heart rate >90 beats per minute, respiratory rate >20 breaths per minute or PaCO2 < 32 mmHg, or leukocytes >12,000. Another important finding after CPB is that the lungs are also oftentimes negatively affected. Up to 20% of patients after cardiac surgery with CPB need to be ventilated for more than 48 hours because of the pulmonary dysfunction.
Other data
| Title | Adverse Effects of Cardio-Pulmonary Bypass “CPB” on Homeostasis | Other Titles | مضاعفات أجهزة التجاوز القلبي الرئوي علي أجهزة الجسم المختلفة | Authors | Ahmed Hussien Abd El-Fattah Sabry | Issue Date | 2017 |
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