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Extracorporeal hemadsorption may reduce inflammatory reaction in cardiopulmonary bypass (CPB) surgery. Glucocorticoids have been used during open-heart surgery for alleviation of systemic inflammation after CPB. We compared intraoperative hemadsorption and methylprednisolone, with usual care, during complex cardiac surgery on CPB, for inflammatory responses, hemodynamics, and perioperative course. Seventy-six patients with prolonged CPB were recruited and randomized, with 60 included in final analysis. Allocation was into three groups: Methylprednisolone (n = 20), Cytosorb (n = 20), and Control group (usual care, n = 20). Proinflammatory (TNF-α, IL-1β, IL-6, and IL-8) and anti-inflammatory (IL-10) cytokines which complement C5a, CD64, and CD163 expression by immune cells were analyzed within the first five postoperative days, in addition to hemodynamic and clinical outcome parameters. Methylprednisolone group, compared to Cytosorb and Control had significantly lower levels of TNF-α (until the end of surgery, p<0.001), IL-6 (until 48 h after surgery, p<0.001), and IL-8 (until 24 h after surgery, p<0.016). CD64 expression on monocytes was the highest in the Cytosorb group and lasted until the 5th postoperative day (p<0.016). IL-10 concentration (until the end of surgery) and CD163 expression on monocytes (until 48 h after surgery) were the highest in the Methylprednisolone group (p<0.016, for all measurements between three groups). No differences between groups in the cardiac index or clinical outcome parameters were found. Methylprednisolone more effectively ameliorates inflammatory responses after CPB surgery compared to hemadsorption and usual care. Hemadsorption compared with usual care causes higher prolonged expression of CD64 on monocytes but short lasting expression of CD163 on granulocytes. Hemadsorption with CytoSorb® was safe and well tolerated. This trial is registered with clinicaltrials.gov (NCT02666703).

Acute kidney injury (AKI) represents frequent complication after cardiac surgery using cardiopulmonary bypass (CPB). In the hope to enhance earlier more reliable characterization of AKI, we tested the utility of neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C (CysC) in addition to standard creatinine for early determination of AKI after cardiac surgery using CPB. Forty-one patients met the inclusion criteria. Arterial blood samples collected after induction of general anesthesia were used as baseline, further sampling occurred at CPB termination, 2 h after CPB, on the first and second day after surgery. According to AKIN classification 18 patients (44%) developed AKI (AKI1-2 groups) and 23 (56%) did not (non-AKI group). Groups were similar regarding demographics and operative characteristics. CysC levels differed already preoperatively (non-AKI vs. AKI2; P = 0.045; AKI1 vs. AKI2; P = 0.011), while postoperatively AKI2 group differed on the first day and AKI1 on the second regarding non-AKI group (P = 0.004; P = 0.021, respectively). NGAL and creatinine showed significant difference already 2 h after CPB between groups AKI2 and non-AKI and later on the first postoperative day between groups AKI1 and AKI2 (P = 0.028; P = 0.014, respectively). This study shows similar performance of early plasma creatinine and NGAL in patients with preserved preoperative renal function. It demonstrates that creatinine, as well as NGAL, differentiate subsets of patients developing AKI of clinically more advanced grade early after 2 h, also when used single and uncombined.

Aim To prospectively assess the antiinflammatory effect of volatile anesthetic sevoflurane in patients undergoing open lung surgery with one lung ventilation (OLV). Methods This prospective, randomized study included 40 patients undergoing thoracic surgery with OLV (NCT02188407). The patients were randomly allocated into two equal groups that received either propofol or sevoflurane. Four patients were excluded from the study because after surgery they received blood transfusion or non-steroid antiinflammatory drugs. Inflammatory mediators (interleukins 6, 8, and 10, C-reactive protein [CRP], and procalcitonin) were measured perioperatively. The infiltration of the nonoperated lung was assessed on chest x-rays and the oxygenation index was calculated. The major postoperative complications were counted. Results Interleukin 6 levels were significantly higher in propofol than in sevoflurane group (P = 0.014). Preoperative CRP levels did not differ between the groups (P = 0.351) and in all patients they were lower than 20 mg/L, but postoperative CRP was significantly higher in propofol group (31 ± 6 vs 15 ± 7 ng/L; P = 0.035); Pre- and postoperative procalcitonin was within the reference range (

Severe airway bleeding or massive hemoptysis is a rare condition that carries high mortality. Patients are at risk of life-thretening respiratory compromise due to the airways filling with blood. The main principles in the management of massive hemoptysis are: maintainance of airway patency, localization of the source of bleeding and control of the hemorrhage. Most cases of massive hemoptysis are caused by inflammatory lung diseases such as aspergiloma, tuberculosis and bronchiectasis while a severe bleeding from a malignant lung tumor is a rare find.We present a case of massive hemoptysis in a 60-year old woman, caused by the invasion of lung cancer into the left pulmonary trunk and aorta, which was successfully managed by an extended left pneumonectomy, with the resection of the proximal part of the descending thoracic aorta and interposition of a vascualar graft without extra corporeal circulation. A complete (R0) resection was also achieved.

We admitted a 76-year old male person with a ruptured abdominal aortic aneurysm. He was immediately brought to the emergency room (ER). The blood pressure was 80/40 mmHg, HTC less than 0.17. We decided to perform an emergent CT angiography wich verified referral diagnosis. The ruptured AAA was 12 cm in diameter. An emergent life saving operation had to be done so the patient was brought to the operation theatre (OT). The approach to the abdomen was a classic median laparotomy. After we had opened the abdomen, we found a huge retroperitoneal haematoma that pushed beside the intra-abdominal organs rising almost to the edge of the rectal fascia. The blood pressure suddenly dropped down to 45/25 mm Hg for the next several minutes. A continuous infusion of norepinephrine was administered (60 mcg/min) and we also administered several doses of pure adrenalin (3 mg) and pure norepinephrine (1 mg). We pulled out the intestines from the abdominal cavity and clamped the aorta just under the renal arteries. The blood pressure immediately rose to 80 mm Hg. Both common iliac arteries were clamped, too. During the surgery the patient was anuric. Autologous blood transfusion helped by cell saver was administered and additionally he got several doses of blood, blood derivates (fresh frozen plasma, cryoprecipitate, platelets) and other intravenous solutions at the amount of approximately eight litres. We replaced the ruptured AAA using 20 mm PTFE vascular graft. After surgery the patient was transferred to the intensive care unit (ICU) where the blood pressure rose and diuresis was established. First postoperative day the patient was woken up without neurological deficits. Second postoperative day the patient was able to expel the stool and he was transferred to the department of cardiovascular surgery. Tenth day after surgery he was discharged home. Six weeks after surgery we performed a control CT angiography that showed normal founding on the abdominal iliac and leg vessels.