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CARDIOVASCULAR ANESTHESIA

Neutrophil Number and Interleukin-8 and Elastase Concentrations in Bronchoalveolar Lavage Fluid Correlate with Decreased Arterial Oxygenation After Cardiopulmonary Bypass

Naoki Kotani, MD^*, Hiroshi Hashimoto, MD^*, Daniel I. Sessler, MD, Masatoshi Muraoka, MD^*, Jian-Sheng Wang, MD, Michael F. O’Connor, MD, and Akitomo Matsuki, MD^*

*Department of Anesthesiology, University of Hirosaki School of Medicine, Hirosaki, Japan; Department of Anesthesia and Perioperative Care, University of California–San Francisco, San Francisco, California; and Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois

Address correspondence and reprint requests to Naoki Kotani, MD, Department of Anesthesiology, University of Hirosaki School of Medicine, Hirosaki 036-8562, Japan. Address e-mail to nao{at}cc.hirosaki-u.ac.jp

Atelectasis is a major cause of decreased arterial oxygenation after cardiopulmonary bypass (CPB). There is a close relationship between atelectasis and inflammatory responses. We therefore tested the hypothesis that neutrophil number and the concentrations of proinflammatory cytokines and elastase in plasma and bronchoalveolar lavage fluid correlate with changes in arterial oxygenation. Bronchoalveolar lavage was performed just after the induction of anesthesia and at the end of surgery in 80 patients undergoing CPB. Peripheral blood was sampled simultaneously. Arterial oxygenation was quantified by PaO₂/fraction of inspired oxygen (FIO₂) and intrapulmonary shunt (Q_s/Q_t). PaO₂/FIO₂ and Q_s/Q_t decreased significantly at the end of surgery, whereas neutrophil number, interleukin (IL)-6, IL-8, tumor necrosis factor-, and elastase concentrations in the lavage fluid increased significantly. The increase in neutrophil count from the lavage fluid correlated significantly with the increases in IL-8 and elastase concentrations. The increase in neutrophil number and IL-8 and elastase concentrations in the lavage fluid correlated significantly with PaO₂/FIO₂ and Q_s/Q_t at the end of surgery. In contrast, none of the plasma values correlated with these variables. Significant correlation between immune mediators and decreased arterial oxygenation suggests that inflammatory responses in the distal airway are strongly related to a decrease in arterial oxygenation after CPB.

Implications: The increases in neutrophil number, interleukin-8, and elastase concentrations in bronchoalveolar lavage correlated significantly with decreases in arterial oxygenation. Our results suggest immunologic responses in the distal airway are closely related to pulmonary gas change.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999