In a double blind controlled study of 24 patients undergoing coronary artery bypass grafting, 12 received an infusion of prostacyclin at 20 ng/kg/min during cardiopulmonary bypass in an attempt to reduce the previously reported increased alveolar capillary membrane permeability that occurs postoperatively. Prostacyclin significantly reduced platelet activation but had no effect in reducing complement activation or transpulmonary neutrophil sequestration. Alveolar epithelial permeability as assessed by measuring the clearance of inhaled 99mTc-DTPA from lung to blood did not change postoperatively in either group.
In order to fully evaluate pulmonary damage following cardiopulmonary bypass a marker for pulmonary endothelial damage may need to be used.
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References
1.
Taylor AE, Gaar KAEstimation of equivalent pore radii of pulmonary capillary and alveolar membranes . Am J Physiol1970; 218: 1133-40.
2.
Schneeberger-Keeley EE, Karnovsky MJThe ultrastructural basis of alveolar capillary membrane permeability to peri-oxidase used as a tracer. J Cell Biol1968; 37: 781-93.
3.
Fisher A., Foex P.Adult respiratory distress syndrome. In: Weatherall DJ, Ledingham JGG, Warell DA eds. Oxford textbook of medicine . Oxford: Oxford University Press , 1983: 15.115-15.119.
4.
Jones JG, Royston D., Minty BDChanges in alveolar-capillary barrier function in animals and humans. Am Rev Respir Dis1983; 127 (Number 5 suppl): s51-s59.
5.
Mason GR, Effros RM; Uszler JM, Mena I.Small solute clearance from the lungs of patients with cardiogenic and non-cardiogenic pulmonary edema. Chest1985; 88: 327-34.
6.
Anyanwu E., Dittrich H., Gieseking R., Enders HJUltrastructural changes in the human lung following cardiopulmonary bypass . Basic Res Cardiol1982; 77: 309-22.
7.
Klancke KA, Assey ME, Kratz JM, Crawford FAPostoperative pulmonary edema in postcoronary artery bypass graft patients . Relationship of total serum protein and colloid oncotic pressures. Chest1983; 84: 529-34.
8.
Fowler AA, Hamman RF, Good JT, Benson KN, Baird M., Eberle DJ, Petty TL, Hyers TMAdult respiratory distress syndrome: risk with common predispositions. Ann Intern Med1983; 98: 593-97.
Chenoweth DE, Cooper SW, Hugli TE, Stewart RW, Blackstone EH, Kirklin JWComplement activation during cardiopulmonary bypass. Evidence for generation of C3a and C5a anaphylotoxins. N Engl J Med1981; 304: 497-503.
11.
Royston D., Minty BD, Higenbottam T., Jones JG, Wallwork J.The effect of surgery with cardiopulmonary bypass on alveolar-capillary barrier function in human beings. Ann Thorac Surg1985; 40: 139-43.
Ubatuba FB, Moncada S., Vane JRThe effect of prostacyclin on platelet behaviour, thrombus formation in vivo and bleeding time. Thromb Haemost1979; 41: 425-35.
14.
Jones G., Hurley JVThe effect of prostacyclin on the adhesion of leucocytes to injured vascular endothelium. J Pathol1984; 142: 51-59.
15.
Vane JRAdventures and excursions in bioassay—the stepping stones to prostacyclin . Postgrad Med J1983; 59: 743-58.
16.
Longmore DB , Hoyle PM, Gregory A., Bennet JG, Smith MA, Osivand T., Jones WAProstacyclin administration during cardiopulmonary bypass in man. Lancet1981; i: 800-804.
17.
Walker ID, Davidson JF, Faichney A., Wheatley DJ, Davidson KGA double blind study of prostacyclin in cardiopulmonary bypass surgery. Br J Haematol1981; 49: 415-23.
18.
Ruddy S., Gigli I., Austen KFThe complement system of man. N Engl J Med1972; 287: 489-95.
19.
Westaby S.Complement and the damaging effects of cardiopulmonary bypass. Thorax1983; 38: 321-25.
20.
Collet B., Alhaq A., Abdullah NB, Korjtsas L., Ware RJ, Dodd NJ, Alimo E., Ponte J., Vergani D.Pathways to complement activation during cardiopulmonary bypass. Br Med J1984; 289: 1251-54.
21.
Cheu-Jeng Chiu R., Samson R.Complement (C3, C4) consumption in cardiopulmonary bypass, cardioplegia and protamine administration. Ann Thorac Surg1984; 37: 229-32.
22.
Fehr, J., Rohr H.In vivo complement activation by polyanion-polycation complexes: evidence that C5a is generated intravascularly during heparin-protamine interaction . Clin Immunol Immunopath1983; 29: 7-14.
23.
Zimmerman GA , Amory DWTranspulmonary polymorphonuclear leucocyte number after cardiopulmonary bypass. Am Rev Respir Dis1982; 126: 1097-98.
Ratcliff NB , Young WG, Hackel DB, Mikat E., Wilson JWPulmonary injury secondary to extracorporeal circulation. An ultrastructural study. J Thorac Cardiovasc Surg1973; 65: 425-32.
