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Respiration 1990;57:233-238
Alterations of the Endoalveolar Surfactant after Surgery with Extracorporeal Circulation S. Marcatili+a, C. Guarino ' , A . Giannattasioh, A. Marcatili\ M. Festac, V. Cautiero\ M.G. Marinid, P. PierfedericiA, S. Dell'Orsoe, M. Cotrufoc, E. Catena a Departments of a Phthisiology and Diseases of the Respiratory System, b Biological Chemistry and c Heart Surgery and Surgery of Large Vessels, I Medical Faculty, University of Naples, and Departments of J Medicine and c Statistics, De Angeli Institute, Boehringer Ingelheim Italia, Milan, Italy
Key Words. Ambroxol • Extracorporeal circulation • Pulmonary surfactant • Phospholipids • Bronchoalveolar lavage Abstract. In 10 patients who required extracorporeal circulation (ECC) during surgery, we studied the dam age induced by surgery to the pulmonary surfactant and the effectiveness of ambroxol in preventing changes in the phospholipid pool. There were 5 control patients and 5 patients who were given 1 g/day of ambroxol on the 4 days prior to and the 4 days after surgery. To follow changes in phospholipid concentrations, bronchoalveo lar lavage (BAL) was performed before surgery and 24 h and 8 days after ECC. Phospholipids were assayed in the BAL liquid by two-dimensional thin-layer chromatography. There were marked decreases in total phos phorus and quantitative alterations of individual phospholipid species in the surfactant of the control group, but not in the patients treated with ambroxol.
The incidence of pulmonary complications follow ing surgery with extracorporeal circulation (ECC) is difficult to establish because it varies from one sur gical team to another and because of the different methods of study. Nevertheless, a statistical review (table 1) performed some years ago revealed that after surgery with ECC slight and severe pulmonary com plications occur in about 50% of cases [1-9]. Radio logical alterations, such as pulmonary involvement, from thin lamellar striations of atelectasis to very ex tended radiopaque images, are even more numerous, with a frequency of up to about 75%. Severe compli cations occur more rarely (5-10%). Today, thanks to the improvement of techniques for ECC and the remarkable shortening of the dura tion of surgery, the frequency of pulmonary pathol ogy after ECC has significantly decreased. Nevertheless, they do still occur in a not negligible number of cases and, sometimes, they require a con siderable clinical effort [10, 11]. Pulmonary alter ations that are due to ECC are characterized clinically as respiratory failure with tachypnoea, cyanosis and
Table 1. Pulmonary complications after cardiopulmonary by pass Authors
Year
Dodrill [1] Templeton et al. [2] Provan et al. [3] Connolly [4] G auertet al. [5] Llamas and Fortaman [6] Turnbull et al. [7] Foliguet and Helmer [8] Kirklinet al. [9]
1958 1966 1973 1967 1971
Overall frequency %
Radiological alterations %
25.0 74.0 61.5 50.0
19.8 20.0 18.0
70.0
5.3
1973 1974 1975 1983
Severe forms %
84.0 45.0 35.0
2.5
69.0
hypoxemia and, radiologically, as diffuse pulmonary opacities of different entity and kind. Their etiopathogenesis can have several causes, such as, mainly, damage to the endoalveolar surfactant. Indeed, mor phologically, numerous electron ultramicroscopic ob servations have shown damage to type-II pneumo-
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Introduction
234
Marcatili/Guarino/Giannattasio/Marcatili/Festa/Cautiero/Marini/Pierfederici/DeU’Orso/Cotrufo/Catena
Table 2. Total phosphorus at the different times of BAL (mean ± SE) Absolute total phosphorus. pg/ml before ECC
24 h after ECC
8 days after ECC
14.00-, 12.00
f 1 10.00 M
2
1& 8.00 M o
I- 6.00 2
8.29 ± 0.66
4.0710.34
6.2410.48
6.8510.24
9.0410.40
12.3510.47
0
1 4 .0 0 -|
I
2.00 0.0 0-I
Control group (n = S)
Student’s t test for unpaired data:
p = NS
p < 0 .0 l
p
Respiration 1990;57:233-238
Alterations of the Endoalveolar Surfactant after Surgery with Extracorporeal Circulation S. Marcatili+a, C. Guarino ' , A . Giannattasioh, A. Marcatili\ M. Festac, V. Cautiero\ M.G. Marinid, P. PierfedericiA, S. Dell'Orsoe, M. Cotrufoc, E. Catena a Departments of a Phthisiology and Diseases of the Respiratory System, b Biological Chemistry and c Heart Surgery and Surgery of Large Vessels, I Medical Faculty, University of Naples, and Departments of J Medicine and c Statistics, De Angeli Institute, Boehringer Ingelheim Italia, Milan, Italy
Key Words. Ambroxol • Extracorporeal circulation • Pulmonary surfactant • Phospholipids • Bronchoalveolar lavage Abstract. In 10 patients who required extracorporeal circulation (ECC) during surgery, we studied the dam age induced by surgery to the pulmonary surfactant and the effectiveness of ambroxol in preventing changes in the phospholipid pool. There were 5 control patients and 5 patients who were given 1 g/day of ambroxol on the 4 days prior to and the 4 days after surgery. To follow changes in phospholipid concentrations, bronchoalveo lar lavage (BAL) was performed before surgery and 24 h and 8 days after ECC. Phospholipids were assayed in the BAL liquid by two-dimensional thin-layer chromatography. There were marked decreases in total phos phorus and quantitative alterations of individual phospholipid species in the surfactant of the control group, but not in the patients treated with ambroxol.
The incidence of pulmonary complications follow ing surgery with extracorporeal circulation (ECC) is difficult to establish because it varies from one sur gical team to another and because of the different methods of study. Nevertheless, a statistical review (table 1) performed some years ago revealed that after surgery with ECC slight and severe pulmonary com plications occur in about 50% of cases [1-9]. Radio logical alterations, such as pulmonary involvement, from thin lamellar striations of atelectasis to very ex tended radiopaque images, are even more numerous, with a frequency of up to about 75%. Severe compli cations occur more rarely (5-10%). Today, thanks to the improvement of techniques for ECC and the remarkable shortening of the dura tion of surgery, the frequency of pulmonary pathol ogy after ECC has significantly decreased. Nevertheless, they do still occur in a not negligible number of cases and, sometimes, they require a con siderable clinical effort [10, 11]. Pulmonary alter ations that are due to ECC are characterized clinically as respiratory failure with tachypnoea, cyanosis and
Table 1. Pulmonary complications after cardiopulmonary by pass Authors
Year
Dodrill [1] Templeton et al. [2] Provan et al. [3] Connolly [4] G auertet al. [5] Llamas and Fortaman [6] Turnbull et al. [7] Foliguet and Helmer [8] Kirklinet al. [9]
1958 1966 1973 1967 1971
Overall frequency %
Radiological alterations %
25.0 74.0 61.5 50.0
19.8 20.0 18.0
70.0
5.3
1973 1974 1975 1983
Severe forms %
84.0 45.0 35.0
2.5
69.0
hypoxemia and, radiologically, as diffuse pulmonary opacities of different entity and kind. Their etiopathogenesis can have several causes, such as, mainly, damage to the endoalveolar surfactant. Indeed, mor phologically, numerous electron ultramicroscopic ob servations have shown damage to type-II pneumo-
Downloaded by: Karolinska Institutet, University Library 130.237.122.245 - 1/17/2019 2:36:55 PM
Introduction
234
Marcatili/Guarino/Giannattasio/Marcatili/Festa/Cautiero/Marini/Pierfederici/DeU’Orso/Cotrufo/Catena
Table 2. Total phosphorus at the different times of BAL (mean ± SE) Absolute total phosphorus. pg/ml before ECC
24 h after ECC
8 days after ECC
14.00-, 12.00
f 1 10.00 M
2
1& 8.00 M o
I- 6.00 2
8.29 ± 0.66
4.0710.34
6.2410.48
6.8510.24
9.0410.40
12.3510.47
0
1 4 .0 0 -|
I
2.00 0.0 0-I
Control group (n = S)
Student’s t test for unpaired data:
p = NS
p < 0 .0 l
p
