Highest core temperature during cardiopulmonary bypass and rate of mediastinitis

Abstract

Temperature control during cardiopulmonary bypass (CPB) may be related to rates of bacterial infection. We assessed the relationship between highest core temperature during CPB and rates of mediastinitis in 6955 consecutive isolated coronary artery bypass graft (CABG) procedures in northern New England.

The overall rate of mediastinitis was 1.1%. The association between highest core temperature and mediastinitis was different for diabetics than for nondiabetics. A multivariate model showed that there was a significant interaction between diabetes and temperature in their association with mediastinitis (p = 0.015). Diabetic patients showed higher rates of mediastinitis as highest core temperature increased, from 0.7% in the ≤37°C group to 3.3% in the ≥38°C group (p _trend = 0.002). Adjusted rates were similar. Nondiabetic patients did not show this trend (p _trend = 0.998).

Among diabetic patients, a peak core body temperature > 37.9°C during CPB is a significant risk factor for development of mediastinitis. Avoidance of higher temperatures during CPB may lower the risk of mediastinitis for diabetic patients undergoing CABG surgery.

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References

Catenaccio M , Chindamo D , Lorenzini S , et al. Temperature influence on stimulated PMN respiratory burst . Boll Soc Ital Biol Sper 1999; 75: 47-53 .

Braxton JH , Marrin CA , McGrath PD , et al. Mediastinitis and long-term survival after coronary artery bypass graft surgery. Northern New England Cardiovascular Disease Study Group . Ann Thorac Surg 2000; 70: 2004-2007 .

Fietsam R, Jr. , Bassett J , Glover JL. Complications of coronary artery surgery in diabetic patients . Am Surg 1991; 57: 551-557 .

Zacharias A , Habib RH. Factors predisposing to median sternotomy complications. Deep vs superficial infection . Chest 1996; 110: 1173-1178 .

Slaughter MS , Olson MM , Lee JT, Jr. , Ward HB. A fifteen-year wound surveillance study after coronary artery bypass . Ann Thorac Surg 1993; 56: 1063-1068 .

L’Ecuyer PB , Murphy D , Little JR , Fraser VJ. The epidemiology of chest and leg wound infections following cardiothoracic surgery . Clin Infect Dis 1996; 22: 424-429 .

Spelman DW , Russo P , Harrington G , et al. Risk factors for surgical wound infection and bacteraemia following coronary artery bypass surgery . Aust NZ J Surg 2000; 70: 47-51 .

Vuorisalo S , Haukipuro K , Pokela R , Syrjala H. Risk features for surgical-site infections in coronary artery bypass surgery . Infect Control Hosp Epidemiol 1998; 19: 240-247 .

O’Connor GT , Plume SK , Olmstead EM , et al. Multivariate prediction of in-hospital mortality associated with coronary artery bypass graft surgery. Northern New England Cardiovascular Disease Study Group [see comments] . Circulation 1992; 85: 2110-2118 .

10.

Duff GW. Is fever beneficial to the host: a clinical perspective . Yale J Biol Med 1986; 59: 125-130 .

11.

Takada Y , Sato EF , Nakajima T , et al. Granulocyte-colony stimulating factor enhances anti-tumour effect of hyperthermia . Int J Hyperthermia 2000; 16: 275-286 .

12.

Roberts NJ, Jr. , Steigbigel RT. Hyperthermia and human leukocyte functions: effects on response of lymphocytes to mitogen and antigen and bactericidal capacity of monocytes and neutrophils . Infect Immun 1977; 18: 673-679 .

13.

Kappel M , Poulsen TD , Hansen MB , Galbo H , Pedersen BK. Somatostatin attenuates the hyperthermia induced increase in neutrophil concentration . Eur J Appl Physiol Occup Physiol 1998; 77: 149-156 .

14.

Hiruma M , Kagawa S. Effects of hyperthermia on phagocytosis and intracellular killing of Sporothrix schenckii by polymorphonuclear leukocytes . Mycopathologia 1986; 95: 93-100 .

15.

Roberts HJ. Impact of temperature elevation on immunologic defenses . Rev Infect Dis 1991; 13: 462-472 .

16.

Ulicny KS, Jr. , Hiratzka LF. Nutrition and the cardiac surgical patient . Chest 1992; 101: 836-842 .

17.

Kouchoukos NT , Wareing TH , Murphy SF , Pelate C , Marshall WG, Jr. Risks of bilateral internal mammary artery bypass grafting . Ann Thorac Surg 1990; 49: 210-217 ; discussion 217-19.

18.

Mowat A , Baum J. Chemotaxis of polymorphonuclear leukocytes from patients with diabetes mellitus . N Engl J Med 1971; 284: 621-627 .

19.

Bagdade JD , Root RK , Bulger RJ. Impaired leukocyte function in patients with poorly controlled diabetes . Diabetes 1974; 23: 9-15 .

20.

Nielson CP , Hindson DA. Inhibition of polymorpho-nuclear leukocyte respiratory burst by elevated glucose concentrations in vitro . Diabetes 1989; 38: 1031-1035 .

21.

Ortmeyer J , Mohsenin V. Glucose suppresses super-oxide generation in normal neutrophils: interference in phospholipase D activation . Am J Physiol 1993; 264: C402-C410 .

22.

Gallacher SJ , Thomson G , Fraser WD , Fisher BM , Gemmell CG , MacCuish AC. Neutrophil bactericidal function in diabetes mellitus: evidence for association with blood glucose control . Diabet Med 1995; 12: 916-920 .

23.

Sato N , Kashima K , Shimizu H , Uehara Y , Shimomura Y , Mori M. Hypertonic glucose inhibits the production of oxygen-derived free radicals by rat neutrophils . Life Sci 1993; 52: 1481-1486 .

24.

Lin X , Candlish JK , Thai AC. Superoxide production by neutrophils from diabetics and normal subjects in response to glucose and galactose . Exp Mol Pathol 1993; 58: 229-236 .

25.

Ortmeyer J , Mohsenin V. Inhibition of phospholipase D and superoxide generation by glucose in diabetic neutrophils . Life Sci 1996; 59: 255-262 .

26.

Nakamura M , Morikawa M , Koike H , et al. Reduction in cellular immunity in diabetics receiving coronary artery bypass grafting . Nippon Kyobu Geka Gakkai Zasshi 1994; 42: 1875-1884 .

27.

Rassias AJ , Marrin CA , Arruda J , Whalen PK , Beach M , Yeager MP. Insulin infusion improves neutrophil function in diabetic cardiac surgery patients . Anesth Analg 1999; 88: 1011-1016 .

28.

Van den Berghe G , Wouters P , Weekers F , et al. Intensive insulin therapy in critically ill patients . N Engl J Med 2001; 345: 1359-1367 .

29.

Furnary AP , Zerr KJ , Grunkemeier GL , Starr A. Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures . Ann Thorac Surg 1999; 67: 352-360 ; discussion 360-62.

30.

Oldenborg PA , Sehlin J. Insulin-stimulated chemokinesis in normal human neutrophils is dependent on D-glucose concentration and sensitive to inhibitors of tyrosine kinase and phosphatidylinositol 3-kinase . J Leukoc Biol 1998; 63: 203-208 .

31.

Oldenborg PA. Effects of insulin on N-formyl-methionyl-leucyl-phenylalanine (fMet-Leu-Phe)-stimulated production of reactive oxygen metabolites from normal human neutrophils . Inflamm Res 1999; 48: 404-411 .

32.

Inoue T , Saito H , Matsuda T , et al. Growth hormone and insulin-like growth factor I augment bactericidal capacity of human polymorphonuclear neutrophils . Shock 1998; 10: 278-284 .

33.

Safronova VG , Gabdoulkhakova AG , Miller AV , Kosarev IV , Vasilenko RN. Variations of the effect of insulin on neutrophil respiratory burst. The role of tyrosine kinases and phosphatases . Biochemistry (Mosc) 2001; 66: 840-849 .

34.

Lehot JJ , Piriz H , Villard J , Cohen R , Guidollet J. Glucose homeostasis. Comparison between hypothermic and normothermic cardiopulmonary bypass . Chest 1992; 102: 106-111 .

35.

Chaney MA , Nikolov MP , Blakeman BP , Bakhos M. Attempting to maintain normoglycemia during cardiopulmonary bypass with insulin may initiate postoperative hypoglycemia . Anesth Analg 1999; 89: 1091-1095 .

36.

Rassias AJ , Givan AL , Marrin CA , Whalen K , Pahl J , Yeager MP. Insulin increases neutrophil count and phagocytic capacity after cardiac surgery . Anesth Analg 2002; 94: 1113-1119 , table of contents.

37.

Elgebaly SA , Hashmi FH , Houser SL , Allam ME , Doyle K. Cardiac-derived neutrophil chemotactic factors: detection in coronary sinus effluents of patients undergoing myocardial revascularization . J Thorac Cardiovasc Surg 1992; 103: 952-959 .

38.

Gadaleta D , Fahey AL , Verma M , et al. Neutrophil leukotriene generation increases after cardiopulmonary bypass . J Thorac Cardiovasc Surg 1994; 108: 642-647 .

39.

Gillinov AM , Redmond JM , Zehr KJ , et al. Inhibition of neutrophil adhesion during cardiopulmonary bypass . Ann Thorac Surg 1994; 57: 126-133 .

40.

Haddad R , El-Hassan D , Araj A , Hallal A , Abdelnoor AM. Some inflammation-related parameters in patients following normo- and hypothermic cardio-pulmonary bypass . Immunopharmacol Immunotoxicol 2001; 23: 291-302 .

41.

Chew MS , Brandslund I , Brix-Christensen V et al. Tissue injury and the inflammatory response to pediatric cardiac surgery with cardiopulmonary bypass: a descriptive study . Anesthesiology 2001; 94: 745-753 ; discussion 5A.