Steroids and Microcirculation In Cardiac Surgery

Summary

Cardiac surgery is sometimes associated with organ dysfunction of variable severity (renal insufficiency, cognitive decline, arrhythmias, ARDS). The phenomenon responsible is an intense inflammatory reaction induced by cardiopulmonary bypass, leading to microcirculation alterations, specially in endothelial cell and its protective layer - glycocalyx. Endothelial dysfunction then reduces the reactivity of peripheral tissues to hypoxia, and is associated with bad prognosis. High - dose corticoids administration at anesthesia induction in cardiac surgery could attenuate the intensity of this inflammatory reaction, and represents the current practice in our hospital. Nevertheless, this attitude is abandoned in numerous cardiac surgery centres.

Timeline

Start

2016-05

Primary completion

2021-09

Completion

2021-09

Publications

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• Background Wan S, LeClerc JL, Vincent JL. Inflammatory response to cardiopulmonary bypass: mechanisms involved and possible therapeutic strategies. Chest. 1997 Sep;112(3):676-92. doi: 10.1378/chest.112.3.676.
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• Background Warren OJ, Watret AL, de Wit KL, Alexiou C, Vincent C, Darzi AW, Athanasiou T. The inflammatory response to cardiopulmonary bypass: part 2--anti-inflammatory therapeutic strategies. J Cardiothorac Vasc Anesth. 2009 Jun;23(3):384-93. doi: 10.1053/j.jvca.2008.09.007. Epub 2008 Dec 3. No abstract available.
• Background Whitlock RP, Chan S, Devereaux PJ, Sun J, Rubens FD, Thorlund K, Teoh KH. Clinical benefit of steroid use in patients undergoing cardiopulmonary bypass: a meta-analysis of randomized trials. Eur Heart J. 2008 Nov;29(21):2592-600. doi: 10.1093/eurheartj/ehn333. Epub 2008 Jul 28.
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• Background Whitlock RP, Devereaux PJ, Teoh KH, Lamy A, Vincent J, Pogue J, Paparella D, Sessler DI, Karthikeyan G, Villar JC, Zuo Y, Avezum A, Quantz M, Tagarakis GI, Shah PJ, Abbasi SH, Zheng H, Pettit S, Chrolavicius S, Yusuf S; SIRS Investigators. Methylprednisolone in patients undergoing cardiopulmonary bypass (SIRS): a randomised, double-blind, placebo-controlled trial. Lancet. 2015 Sep 26;386(10000):1243-1253. doi: 10.1016/S0140-6736(15)00273-1.
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• Background Alley H, Owens CD, Gasper WJ, Grenon SM. Ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery in clinical research. J Vis Exp. 2014 Oct 22;(92):e52070. doi: 10.3791/52070.
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• Background Sangalli F, Guazzi M, Senni S, Sala W, Caruso R, Costa MC, Formica F, Avalli L, Fumagalli R. Assessing Endothelial Responsiveness After Cardiopulmonary Bypass: Insights on Different Perfusion Modalities. J Cardiothorac Vasc Anesth. 2015 Aug;29(4):912-6. doi: 10.1053/j.jvca.2014.11.008. Epub 2014 Nov 11.
• Background De Backer D, Durand A. Monitoring the microcirculation in critically ill patients. Best Pract Res Clin Anaesthesiol. 2014 Dec;28(4):441-51. doi: 10.1016/j.bpa.2014.09.005. Epub 2014 Sep 28.
• Background Cohn SM, Nathens AB, Moore FA, Rhee P, Puyana JC, Moore EE, Beilman GJ; StO2 in Trauma Patients Trial Investigators. Tissue oxygen saturation predicts the development of organ dysfunction during traumatic shock resuscitation. J Trauma. 2007 Jan;62(1):44-54; discussion 54-5. doi: 10.1097/TA.0b013e31802eb817.
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• Background Monthe-Sagan K, Fischer MO, Saplacan V, Gerard JL, Hanouz JL, Fellahi JL. Near-infrared spectroscopy to assess microvascular dysfunction: A prospective pilot study in cardiac surgery patients. J Crit Care. 2016 Feb;31(1):264-8. doi: 10.1016/j.jcrc.2015.09.026. Epub 2015 Oct 9.
• Background Fellahi JL, Butin G, Fischer MO, Zamparini G, Gerard JL, Hanouz JL. Dynamic evaluation of near-infrared peripheral oximetry in healthy volunteers: a comparison between INVOS and EQUANOX. J Crit Care. 2013 Oct;28(5):881.e1-6. doi: 10.1016/j.jcrc.2013.05.004. Epub 2013 Jun 13.
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• Background Nussbaum C, Haberer A, Tiefenthaller A, Januszewska K, Chappell D, Brettner F, Mayer P, Dalla Pozza R, Genzel-Boroviczeny O. Perturbation of the microvascular glycocalyx and perfusion in infants after cardiopulmonary bypass. J Thorac Cardiovasc Surg. 2015 Dec;150(6):1474-81.e1. doi: 10.1016/j.jtcvs.2015.08.050. Epub 2015 Aug 24.
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• Background Panagiotopoulos I, Palatianos G, Michalopoulos A, Chatzigeorgiou A, Prapas S, Kamper EF. Alterations in biomarkers of endothelial function following on-pump coronary artery revascularization. J Clin Lab Anal. 2010;24(6):389-98. doi: 10.1002/jcla.20416.
• Background Stoner L, Tarrant MA, Fryer S, Faulkner J. How should flow-mediated dilation be normalized to its stimulus? Clin Physiol Funct Imaging. 2013 Jan;33(1):75-8. doi: 10.1111/j.1475-097X.2012.01154.x. Epub 2012 Jul 25.
• Background Kanahara M, Harada H, Katoh A, Ikeda H. New methodological approach to improve reproducibility of brachial artery flow-mediated dilatation. Echocardiography. 2014 Feb;31(2):197-202. doi: 10.1111/echo.12307. Epub 2013 Jul 30.
• Background Barderas R, Mendes M, Torres S, Bartolome RA, Lopez-Lucendo M, Villar-Vazquez R, Pelaez-Garcia A, Fuente E, Bonilla F, Casal JI. In-depth characterization of the secretome of colorectal cancer metastatic cells identifies key proteins in cell adhesion, migration, and invasion. Mol Cell Proteomics. 2013 Jun;12(6):1602-20. doi: 10.1074/mcp.M112.022848. Epub 2013 Feb 26.

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Indications