Myocardial ischemia-reperfusion injury and systemic inflammatory response in high-risk cardiac surgery:a clinical study of the effects of high-dose glucose-insulin treatment and the use of leukocyte-depleting filter

Abstract Cardiac surgery with cardiopulmonary bypass induces the activation of systemic inflammatory response syndrome (SIRS) and results in at least some degree of global myocardial ischemia. Although these responses are usually short-lived, they may lead to serious complications and organ system...

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Main Author: Koskenkari, J. (Juha)
Format: Doctoral Thesis
Language:English
Published: University of Oulu 2006
Subjects:
Online Access:http://urn.fi/urn:isbn:9514282094
http://nbn-resolving.de/urn:isbn:9514282094
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spelling ndltd-oulo.fi-oai-oulu.fi-isbn951-42-8209-42017-10-14T04:17:34ZMyocardial ischemia-reperfusion injury and systemic inflammatory response in high-risk cardiac surgery:a clinical study of the effects of high-dose glucose-insulin treatment and the use of leukocyte-depleting filterKoskenkari, J. (Juha)info:eu-repo/semantics/openAccess© University of Oulu, 2006info:eu-repo/semantics/altIdentifier/pissn/0355-3221info:eu-repo/semantics/altIdentifier/eissn/1796-2234cardiopulmonary bypassglucoseinsulinleukocyte reduction proceduresmyocardial reperfusion injurysystemic inflammatory responsethoracic surgery Abstract Cardiac surgery with cardiopulmonary bypass induces the activation of systemic inflammatory response syndrome (SIRS) and results in at least some degree of global myocardial ischemia. Although these responses are usually short-lived, they may lead to serious complications and organ system failures. The present study evaluated the effects of high-dose glucose-insulin (1IU/kg/h) treatment (GIK) administered with the hyperinsulinemic normoglycemic clamp technique and a leukocyte-depleting filter on markers of systemic inflammatory response and myocardial ischemia-reperfusion injury in certain cardiac surgical risk groups. The study involved four prospective randomized controlled clinical trials and 119 patients. Cardioprotective effects were measured as myocardial enzyme release, recovery of contractile function and incidence of arrhythmias in all studies. The hemodynamic and metabolic effects of high-dose glucose-insulin treatment were evaluated in patients admitted for combined aortic valve (AS) and coronary surgery (40) and for urgent coronary surgery (39), and the latter study also involved proinflammatory cytokine and C-reactive protein analyses. The impacts of leukocyte filter on the expression of neutrophil adhesion molecules along with proinflammatory cytokines were evaluated in patients admitted for combined aortic valve (AS) and coronary surgery (20) and for solitary coronary surgery (20). The high-dose glucose-insulin treatment was associated with better preserved myocardial contractile function and less need for inotropic support after combined aortic valve and coronary surgery (I) and attenuation of postoperative CRP release after urgent coronary surgery (II). No effects on postoperative myocardial enzyme release (I, II) or on proinflammatory cytokine responses (II) were detected. The number of hypoglycemic events was low. The use of a leukocyte filter throughout the cardiopulmonary bypass period increased the neutrophil adhesion molecule CD11b expression in patients with both normal and prolonged CPB times and was associated with an enhanced proinflammatory cytokine response (III, IV). In conclusion, high-dose glucose-insulin treatment is safe, but requires strict control of blood glucose level. It reduces the need for inotropic support in patients with compromised cardiac status. The use of leukocyte filter leads to increased leukocyte activation and proinflammatory reaction. University of Oulu2006-10-03info:eu-repo/semantics/doctoralThesisinfo:eu-repo/semantics/publishedVersionapplication/pdfhttp://urn.fi/urn:isbn:9514282094urn:isbn:9514282094eng
collection NDLTD
language English
format Doctoral Thesis
sources NDLTD
topic cardiopulmonary bypass
glucose
insulin
leukocyte reduction procedures
myocardial reperfusion injury
systemic inflammatory response
thoracic surgery
spellingShingle cardiopulmonary bypass
glucose
insulin
leukocyte reduction procedures
myocardial reperfusion injury
systemic inflammatory response
thoracic surgery
Koskenkari, J. (Juha)
Myocardial ischemia-reperfusion injury and systemic inflammatory response in high-risk cardiac surgery:a clinical study of the effects of high-dose glucose-insulin treatment and the use of leukocyte-depleting filter
description Abstract Cardiac surgery with cardiopulmonary bypass induces the activation of systemic inflammatory response syndrome (SIRS) and results in at least some degree of global myocardial ischemia. Although these responses are usually short-lived, they may lead to serious complications and organ system failures. The present study evaluated the effects of high-dose glucose-insulin (1IU/kg/h) treatment (GIK) administered with the hyperinsulinemic normoglycemic clamp technique and a leukocyte-depleting filter on markers of systemic inflammatory response and myocardial ischemia-reperfusion injury in certain cardiac surgical risk groups. The study involved four prospective randomized controlled clinical trials and 119 patients. Cardioprotective effects were measured as myocardial enzyme release, recovery of contractile function and incidence of arrhythmias in all studies. The hemodynamic and metabolic effects of high-dose glucose-insulin treatment were evaluated in patients admitted for combined aortic valve (AS) and coronary surgery (40) and for urgent coronary surgery (39), and the latter study also involved proinflammatory cytokine and C-reactive protein analyses. The impacts of leukocyte filter on the expression of neutrophil adhesion molecules along with proinflammatory cytokines were evaluated in patients admitted for combined aortic valve (AS) and coronary surgery (20) and for solitary coronary surgery (20). The high-dose glucose-insulin treatment was associated with better preserved myocardial contractile function and less need for inotropic support after combined aortic valve and coronary surgery (I) and attenuation of postoperative CRP release after urgent coronary surgery (II). No effects on postoperative myocardial enzyme release (I, II) or on proinflammatory cytokine responses (II) were detected. The number of hypoglycemic events was low. The use of a leukocyte filter throughout the cardiopulmonary bypass period increased the neutrophil adhesion molecule CD11b expression in patients with both normal and prolonged CPB times and was associated with an enhanced proinflammatory cytokine response (III, IV). In conclusion, high-dose glucose-insulin treatment is safe, but requires strict control of blood glucose level. It reduces the need for inotropic support in patients with compromised cardiac status. The use of leukocyte filter leads to increased leukocyte activation and proinflammatory reaction.
author Koskenkari, J. (Juha)
author_facet Koskenkari, J. (Juha)
author_sort Koskenkari, J. (Juha)
title Myocardial ischemia-reperfusion injury and systemic inflammatory response in high-risk cardiac surgery:a clinical study of the effects of high-dose glucose-insulin treatment and the use of leukocyte-depleting filter
title_short Myocardial ischemia-reperfusion injury and systemic inflammatory response in high-risk cardiac surgery:a clinical study of the effects of high-dose glucose-insulin treatment and the use of leukocyte-depleting filter
title_full Myocardial ischemia-reperfusion injury and systemic inflammatory response in high-risk cardiac surgery:a clinical study of the effects of high-dose glucose-insulin treatment and the use of leukocyte-depleting filter
title_fullStr Myocardial ischemia-reperfusion injury and systemic inflammatory response in high-risk cardiac surgery:a clinical study of the effects of high-dose glucose-insulin treatment and the use of leukocyte-depleting filter
title_full_unstemmed Myocardial ischemia-reperfusion injury and systemic inflammatory response in high-risk cardiac surgery:a clinical study of the effects of high-dose glucose-insulin treatment and the use of leukocyte-depleting filter
title_sort myocardial ischemia-reperfusion injury and systemic inflammatory response in high-risk cardiac surgery:a clinical study of the effects of high-dose glucose-insulin treatment and the use of leukocyte-depleting filter
publisher University of Oulu
publishDate 2006
url http://urn.fi/urn:isbn:9514282094
http://nbn-resolving.de/urn:isbn:9514282094
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