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Cardiopulmonary Bypass-Induced Inflammatory Response: Pathophysiology and Treatment

Bronicki, Ronald A. MD, FCCM, FACC1; Hall, Mark MD, FCCM2

Pediatric Critical Care Medicine: August 2016 - Volume 17 - Issue 8 - p S272-S278
doi: 10.1097/PCC.0000000000000759
Organ Systems: Other Organ Systems and Systemic Disorders

Objectives: The objectives of this review are to discuss the pathophysiology of the pro-inflammatory response to the cardiopulmonary bypass circuit, the impact of ischemia reperfusion injury on post-operative organ function, the compensatory anti-inflammatory response and the evidence for immune-modulatory strategies and their impact on outcomes.

Data Source: MEDLINE, PubMed.

Conclusion: Innovations such as the development of more biocompatible surfaces and miniaturized circuits, as well as the increasing expertise of surgeons, anesthesiologists and perfusionists has transformed cardiac surgery and the use of cardiopulmonary bypass into a relatively routine procedure with favorable outcomes. Despite these refinements, the attendant inflammatory response to bypass, ischemia reperfusion injury and the compensatory anti-inflammatory response contribute to post-operative morbidity and mortality. Additional studies are needed to further delineate the impact of immunomodulatory strategies on outcomes.

1Department of Pediatrics, Section of Critical Care Medicine and Cardiology, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX.

2Department of Pediatrics, Section of Critical Care Medicine, Ohio State College of Medicine, Nationwide Children’s Hospital, Columbus, OH.

The authors have disclosed that they do not have any potential conflicts of interest.

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Copyright © 2016 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies