Abstract
Cardiac surgery with cardiopulmonary bypass provokes a systemic inflammatory response syndrome caused by the surgical trauma itself, blood contact with the non-physiological surfaces of the extracorporeal circuit, endotoxemia, and ischemia. The role of endotoxin in the inflammatory response syndrome has been well investigated. In this report, we reviewed recent advances in the understanding of the pathophysiology of the endotoxin release during cardiopulmonary bypass and the possible therapeutic strategies aimed to reduce the endotoxin release or to counteract the inflammatory effects of endotoxin. Although many different strategies to detoxify endotoxins were evaluated, none of them were able to show statistically significant differences in clinical outcome.
Copyright © 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
MeSH terms
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Adrenal Cortex Hormones / therapeutic use
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Alkaline Phosphatase / physiology
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Anti-Infective Agents / therapeutic use
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Antibodies / physiology
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Cardiopulmonary Bypass / adverse effects*
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Cytokines / physiology
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Disaccharides / therapeutic use
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Endotoxins / immunology
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Endotoxins / metabolism*
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Hemoperfusion / methods
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Humans
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Hypothermia, Induced
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Ketanserin / therapeutic use
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Serotonin Antagonists / therapeutic use
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Sugar Phosphates / therapeutic use
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Systemic Inflammatory Response Syndrome / drug therapy
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Systemic Inflammatory Response Syndrome / etiology*
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Systemic Inflammatory Response Syndrome / metabolism
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Taurine / analogs & derivatives
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Taurine / therapeutic use
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Thiadiazines / therapeutic use
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Toll-Like Receptor 4 / antagonists & inhibitors
Substances
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Adrenal Cortex Hormones
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Anti-Infective Agents
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Antibodies
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Cytokines
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Disaccharides
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Endotoxins
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Serotonin Antagonists
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Sugar Phosphates
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Thiadiazines
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Toll-Like Receptor 4
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Taurine
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eritoran
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taurolidine
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Ketanserin
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Alkaline Phosphatase