The aim of this study was to describe and quantify pharmacokinetics of ampicillin used prophylactically in cardiac surgery both with and without cardiopulmonary bypass (CPB) using population pharmacokinetic analysis in order to propose an optimal dosing strategy. Adult patients undergoing cardiac surgery and treated with prophylactic dose of 2 g ampicillin were enrolled to this prospective study. Blood samples were collected according to the study protocol and ampicillin plasma concentrations were measured using HPLC/UV system. A three-stage population pharmacokinetic model using nonlinear mixed-effects modelling approach was developed. Totally 273 blood samples obtained from 20 patients undergoing cardiac surgery with the use of the CPB and 20 patients without CPB use were analyzed. Two-comparmental model best fits ampicillin concentration-time data. Mean ± SD body weight-normalized ampicillin central and peripheral volume of distribution was 0.12 ± 0.02 L/kg and 0.15 ± 0.03 L/kg, respectively, while mean ± SD ampicillin clearance in typical patient with eGFR of 1.5 mL/s/1.73 m2 was 1.17 ± 0.05 L/h. The use of CPB did not significantly affect the pharmacokinetics of ampicillin. When administering 2 g of ampicillin before surgery, an additional dose should be administered to reach the PK/PD target of fT > MIC = 50% if the operation lasts longer than 430 min in patients with moderate to severe renal impairment, 320 min in patients with mild renal impairment, 220 min in patients with normal renal function status or 140 min in patients with an augmented renal clearance.

• Klíčová slova
• Antibiotic prophylaxis, ampicillin, cardiac surgery patients, cardiopulmonary bypass, nonlinear mixed-effects modelling, pharmacokinetics,
• MeSH
• ampicilin MeSH
• antibakteriální látky * terapeutické užití   MeSH
• dospělí MeSH
• kardiochirurgické výkony * MeSH
• kardiopulmonální bypass škodlivé účinky   metody   MeSH
• lidé MeSH
• prospektivní studie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• ampicilin MeSH
• antibakteriální látky * MeSH

SEPARATION from cardiopulmonary bypass (CPB) after cardiac surgery is a progressive transition from full mechanical circulatory and respiratory support to spontaneous mechanical activity of the lungs and heart. During the separation phase, measurements of cardiac performance with transesophageal echocardiography (TEE) provide the rationale behind the diagnostic and therapeutic decision-making process. In many cases, it is possible to predict a complex separation from CPB, such as when there is known preoperative left or right ventricular dysfunction, bleeding, hypovolemia, vasoplegia, pulmonary hypertension, or owing to technical complications related to the surgery. Prompt diagnosis and therapeutic decisions regarding mechanical or pharmacologic support have to be made within a few minutes. In fact, a complex separation from CPB if not adequately treated leads to a poor outcome in the vast majority of cases. Unfortunately, no specific criteria defining complex separation from CPB and no management guidelines for these patients currently exist. Taking into account the above considerations, the aim of the present review is to describe the most common scenarios associated with a complex CPB separation and to suggest strategies, pharmacologic agents, and para-corporeal mechanical devices that can be adopted to manage patients with complex separation from CPB. The routine management strategies of complex CPB separation of 17 large cardiac centers from 14 countries in 5 continents will also be described.

• Klíčová slova
• anesthesia, cardiopulmonary bypass, discontinuation, inotropes, intensive care, separation, ventricular dysfunction, weaning,
• MeSH
• dysfunkce pravé srdeční komory * MeSH
• echokardiografie transezofageální MeSH
• hrudní chirurgie * MeSH
• kardiochirurgické výkony * MeSH
• kardiopulmonální bypass škodlivé účinky   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

OBJECTIVE: Cardiac surgery is known to trigger a systemic inflammatory response. While the use of conventional cardiopulmonary bypass (CPB) results in profound inflammation, modified mini-CPB is considered less harmful. We evaluated the impact of cardiac surgery on the expression of CD162, CD166, CD195 molecules and their association with the type of CPB used. METHODS AND RESULTS: Twenty-four patients were enrolled in our study. Twelve of them were operated using conventional CPB while the other twelve patients underwent surgery with mini-CPB. Blood samples were analysed by flow cytometry. We observed a significant increase in median fluorescence intensity of CD162 and CD195 that peaked instantly after surgery and normalized to the baseline value on the 1st day post surgery, whereas CD166 was initially down-regulated and its median fluorescence intensity (MFI) value increased to the baseline in the next few days. CONCLUSION: We observed immediate changes in the expression of CD162, CD166, and CD195 molecules on the neutrophils after surgery in both study groups of patients. The intensity of the observed changes was significantly greater in the group of patients who underwent conventional CPB compared to patients who underwent mini-CPB cardiac surgery.

• Klíčová slova
• CD162, CD166, CD195, cardiopulmonary bypass, inflammation,
• MeSH
• CD antigeny analýza   imunologie   MeSH
• fetální proteiny analýza   imunologie   MeSH
• kardiopulmonální bypass škodlivé účinky   přístrojové vybavení   metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• membránové glykoproteiny analýza   imunologie   MeSH
• miniinvazivní chirurgické výkony škodlivé účinky   přístrojové vybavení   metody   MeSH
• molekuly buněčné adheze neuronové analýza   imunologie   MeSH
• neutrofily imunologie   MeSH
• receptory CCR5 analýza   imunologie   MeSH
• senioři MeSH
• zánět etiologie   imunologie   prevence a kontrola   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH
• Názvy látek
• ALCAM protein, human MeSH Prohlížeč
• CCR5 protein, human MeSH Prohlížeč
• CD antigeny MeSH
• fetální proteiny MeSH
• membránové glykoproteiny MeSH
• molekuly buněčné adheze neuronové MeSH
• P-selectin ligand protein MeSH Prohlížeč
• receptory CCR5 MeSH

Hereditary spherocytosis is a genetically determined abnormality of red blood cells. It is the most common cause of inherited haemolysis in Europe and North America within the Caucasian population. We document a patient who underwent an aortocoronary bypass procedure on cardiopulmonary bypass. In view of the uncertain tolerance of the abnormal red cells in hereditary spherocytosis to cardiopulmonary bypass, we reviewed the patient's chart and analyzed recorded values of these parameters: free plasma haemoglobin, renal parameters, cystatin C, bilirubin, liver tests, urine samples. From the results, we can see that slight haemolysis-elevated bilirubin in the blood sample and elevated bilirubin and urobilinogen in the urine sample occurred on the first postoperative day. The levels of these parameters slowly decreased during the next postoperative days. There was no real clinical effect of this haemolysis on renal functions.

• Klíčová slova
• cardiac surgery, cardiopulmonary bypass, haemolysis, hereditary spherocytosis,
• MeSH
• ankyriny nedostatek   MeSH
• dědičná sférocytóza etiologie   terapie   MeSH
• hemolýza MeSH
• kardiopulmonální bypass škodlivé účinky   MeSH
• koronární bypass škodlivé účinky   MeSH
• lidé MeSH
• pooperační komplikace * MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• ankyriny MeSH

BACKGROUND: The aim of this study was to compare the dynamics of two inflammatory response biomarkers pentraxin 3 (PTX3) and C-reactive protein (CRP) after cardiac surgery with particular regard to different postoperative clinical manifestation of inflammatory response. PATIENTS AND METHODS: In this study, 42 patients undergoing open heart surgery with the use of cardiopulmonary bypass were included and divided in two groups according to the extent of clinical manifestation of inflammatory response: Group A (n=21)-patients with different severity of systemic inflammatory response syndrome (SIRS) and Group B (n=21)-patients with uneventful postoperative period (no SIRS). The serum levels of PTX3 and CRP were evaluated and compared at the following time points: before and at the end of surgery, 6 hours, 1st, 3rd, and 7th day after surgery. RESULTS: The dynamics of CRP levels were comparable between both groups and showed the classical characteristics after cardiac surgery with a peak on the 3rd postoperative day (113 vs. 132 mg/L). In contrast, the dynamics of PTX3 showed an earlier increase of serum levels with the peak on the 1st postoperative day in both groups (36.3 vs. 42.7 ng/mL). Importantly, a significant difference of PTX3 levels was found on the 3rd postoperative day (31.1 vs. 7.0 ng/mL; p<0.006) between the two groups showing significantly delayed decrease of PTX3 levels in patients with SIRS (Group A). CONCLUSION: This study demonstrates considerably different dynamics of PTX3 levels after cardiac surgery in patients with SIRS and patients without SIRS, thus it may be indicative to start the appropriate therapy.

• MeSH
• biologické markery krev   MeSH
• C-reaktivní protein metabolismus   MeSH
• časové faktory MeSH
• dospělí MeSH
• kardiochirurgické výkony škodlivé účinky   MeSH
• kardiopulmonální bypass škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mediátory zánětu krev   MeSH
• prediktivní hodnota testů MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• sérový amyloidový protein metabolismus   MeSH
• syndrom systémové zánětlivé reakce krev   diagnóza   etiologie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH
• Názvy látek
• biologické markery MeSH
• C-reaktivní protein MeSH
• mediátory zánětu MeSH
• PTX3 protein MeSH Prohlížeč
• sérový amyloidový protein MeSH

Coronary artery bypass grafting (CABG) is performed with the use of cardiopulmonary bypass (CPB) and cardioplegic arrest (CA) of the heart. The advantage of this technique, alternatively referred to as "on-pump" surgery, resides, for the surgeon, in relatively easy access to and manipulation with the non-beating, bloodless heart. However, the advantage that is, thereby, gained by the patient is paid off by an increased susceptibility to postoperative systemic inflammatory response syndrome (SIRS). Under unfavorable conditions, the inflammatory syndrome may develop into life-threatening forms of MODS (multiple organ dysfunction syndrome) or even MOFS (multiple organ failure syndrome). Deliberate avoidance of CPB, also known as "off-pump" surgery, attenuates early postoperative inflammation throughout its trajectory of SIRS→MODS→MOFS, but, in the long run, there appears to be no substantial difference in the overall mortality rates. In the last years, our knowledge of the pathophysiology of surgical inflammation has increased considerably. Recent findings, highlighting the as yet rather obscure role of pentraxin 3 (PTX3) in these processes, are discussed in this review article.

• Klíčová slova
• alarmins, cardiopulmonary bypass, coronary artery bypass grafting, interleukin-10, pentraxin 3, sterile inflammation,
• MeSH
• antiflogistika imunologie   MeSH
• ateroskleróza imunologie   MeSH
• C-reaktivní protein genetika   imunologie   MeSH
• infarkt myokardu imunologie   MeSH
• interleukin-10 imunologie   MeSH
• kardiopulmonální bypass škodlivé účinky   metody   MeSH
• koronární bypass škodlivé účinky   metody   MeSH
• lidé MeSH
• sérový amyloidový protein genetika   imunologie   MeSH
• syndrom systémové zánětlivé reakce etiologie   genetika   imunologie   MeSH
• transkriptom MeSH
• vyvolaná zástava srdce škodlivé účinky   metody   MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH
• Názvy látek
• antiflogistika MeSH
• C-reaktivní protein MeSH
• interleukin-10 MeSH
• PTX3 protein MeSH Prohlížeč
• sérový amyloidový protein MeSH

AIMS: In a group of patients undergoing cardiac surgery performed both with ("on-pump") and without the use ("offpump") of cardiopulmonary bypass (CPB), we studied the changes of neutrophil membrane apoptosis-inducing complex Apo/Fas. METHODS: Expression of Apo/Fas (CD95) on leukocytes was evaluated by flow cytometry. RESULTS: In "on-pump" patients, we found an increase in the expression of CD95 median intensity fluorescence (MFI) on granulocytes from a baseline level median=56, (Q( 1)=45.5, Q(3)=64) to a median=88, (Q(1)=62, Q( 3)=109.5; p<0.01) at the 3(rd) postoperative day and median=74, (Q(1)=63, Q(3)=84.5; p<0.01) at the 7(th) postoperative day. In "off-pump" patients, granulocyte CD95 MFI was median=55, (Q(1)=51, Q(3)=84) before surgery. The significant increase was found on the 3(rd) postoperative day only; median=90, (Q( 1)=66; Q(3)=98; p<0.05). A similar pattern in the CD95 expression was also found if percentage changes of granulocyte CD95 MFI were followed. Moreover, the significantly increased Apo/Fas expression expressed as a percentage change of CD95 MFI was found in "on-pump" patients compared to "off-pump" patients, both at the 3(rd) postoperative day (p<0.05) and at the 7(th) postoperative day (p<0.01). CONCLUSIONS: This is the first direct evidence of increasing densities of the Apo/Fas complex on neutrophils in cardiac surgical patients.

• MeSH
• antigeny CD95 metabolismus   MeSH
• apoptóza imunologie   MeSH
• kardiochirurgické výkony * MeSH
• kardiopulmonální bypass škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• neutrofily cytologie   imunologie   metabolismus   MeSH
• pooperační komplikace imunologie   MeSH
• průtoková cytometrie MeSH
• senioři MeSH
• upregulace imunologie   MeSH
• zánět imunologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH
• Názvy látek
• antigeny CD95 MeSH
• FAS protein, human MeSH Prohlížeč

Hepcidin is a key regulator of iron metabolism and a mediator of anemia in inflammation. Recent in vitro studies recognized prohepcidin as a type II acute phase protein regulating via interleukin-6. The aim of the present study was to investigate the time course of plasma prohepcidin after a large cardiac surgery in relation to IL-6 and other inflammatory parameters. Patients with chronic thromboembolic hypertension (n=22, males/females 14/8, age 51.9+/-10.2 years) underwent pulmonary endarterectomy using cardiopulmonary bypass and deep hypothermic circulatory arrest were included into study. Arterial concentrations of prohepcidin, IL-1beta, IL-6, IL-8, tumor necrosis factor-alpha, and C-reactive protein were measured before/after sternotomy, after circulatory arrest, after separation from bypass, and then 12, 18, 24, 36, 48 h and 72 h after the separation from bypass. Hemodynamic parameters, hematocrit and markers of iron metabolism were followed up. Pulmonary endarterectomy induced a 48% fall in plasma prohepcidin; minimal concentrations were detected after separation from cardiopulmonary bypass. Prohepcidin decline correlated with an extracorporeal circulation time (p<0.01), while elevated IL-6 levels were inversely associated with duration of prohepcidin decline. Postoperative prohepcidin did not correlate with markers of iron metabolism or hemoglobin concentrations within a 72-h period after separation from CPB. Prohepcidin showed itself as a negative acute phase reactant during systemic inflammatory response syndrome associated with a cardiac surgery. Results indicate that the evolution of prohepcidin in postoperative period implies the antagonism of stimulatory effect of IL-6 and contraregulatory factors inhibiting prohepcidin synthesis or increasing prohepcidin clearance.

• MeSH
• arteria pulmonalis chirurgie   MeSH
• biologické markery krev   MeSH
• časové faktory MeSH
• dospělí MeSH
• down regulace MeSH
• endarterektomie * škodlivé účinky   MeSH
• hepcidiny MeSH
• interleukin-6 krev   MeSH
• kardiopulmonální bypass * škodlivé účinky   MeSH
• kationické antimikrobiální peptidy krev   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mediátory zánětu krev   MeSH
• plicní hypertenze krev   etiologie   chirurgie   MeSH
• proteinové prekurzory krev   MeSH
• proteiny akutní fáze metabolismus   MeSH
• sternotomie * škodlivé účinky   MeSH
• syndrom systémové zánětlivé reakce krev   etiologie   MeSH
• tromboembolie krev   komplikace   chirurgie   MeSH
• výsledek terapie MeSH
• zástava krevního oběhu vyvolaná hlubokou hypotermií * škodlivé účinky   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• biologické markery MeSH
• hepcidiny MeSH
• IL6 protein, human MeSH Prohlížeč
• interleukin-6 MeSH
• kationické antimikrobiální peptidy MeSH
• mediátory zánětu MeSH
• proteinové prekurzory MeSH
• proteiny akutní fáze MeSH

BACKGROUND: The scavenger receptor for complexes hemoglobin-haptoglobin (CD163), which is expressed on monocytes/ macrophages, is shed to the body fluids in a soluble form (sCD163). OBJECTIVES: To evaluate the dynamics of sCD163 in the blood of patients undergoing cardiac surgery. PATIENTS AND METHODS: Sixty-one adult patients who underwent coronary artery bypass grafting (CABG) were enrolled in the study. They were assigned to undergo CABG using either cardiopulmonary bypass (CPB), "on-pump", (22 patients), modified CPB, mini "on-pump", (17 patients) or without CPB, "off-pump", (22 patients) surgery. Serum levels of sCD163 in venous blood samples taken before and after surgery, and during an early postoperative period, were evaluated by Macro 163(TM) diagnostic kit (IQ Products, Groningen, NL). RESULTS: Compared to the preoperative levels ("on-pump"; 344 ng/mL, "off-pump"; 314.5 ng/mL, mini-invasive "on-pump"; 336.5 ng/mL) serum levels were elevated at the finish of surgery, reaching maximum at the 1(st) postoperative day ("onpump"; 658 ng/mL; p<0.05, "off-pump"; 810.5 ng/mL; p<0.01; mini-invasive "on-pump"; 663 ng/mL; non-significant).No significant differences regarding the serum levels of sCD163 between different surgical approaches were found. CONCLUSION: Serum level of sCD163 scavenger molecule for hemoglobin is elevated at the end of surgery and at the 1(st) postoperative day, being little influenced by cardiopulmonary bypass.

• MeSH
• antigeny diferenciační myelomonocytární krev   MeSH
• CD antigeny krev   MeSH
• haptoglobiny metabolismus   MeSH
• hemoglobiny metabolismus   MeSH
• kardiopulmonální bypass škodlivé účinky   MeSH
• koronární bypass škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• receptory buněčného povrchu krev   MeSH
• senioři MeSH
• zánět krev   etiologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• antigeny diferenciační myelomonocytární MeSH
• CD antigeny MeSH
• CD163 antigen MeSH Prohlížeč
• haptoglobin-hemoglobin complex MeSH Prohlížeč
• haptoglobiny MeSH
• hemoglobiny MeSH
• receptory buněčného povrchu MeSH

Heart valve surgery carries a high risk of renal insufficiency as an independent risk factor due to prolonged cardiopulmonary bypass. Multiple causes of cardiopulmonary bypass-associated renal damage have been described, and haemoglobin-induced renal injury is presently being investigated. Forty-three patients scheduled for heart valve surgery (mostly combined) were enrolled in the prospective study. Plasma free haemoglobin (PFH) levels were evaluated by photocolorimetric measurement at the start of procedures (t(0)) and before the end of extracorporeal circulation (t(1)). A statistically significant increase in PFH levels during cardiopulmonary bypass was detected [median values (interquartile range) - t(0): 62.0 (53.4) mg/L, t(1): 320.4 (352.2) mg/L], P < 0.001. A significant regression relationship between the duration of cardiopulmonary bypass and the increased PFH was found (Spearman's correlation coefficient 0.628, P < 0.001). In some elderly patients, the tendency towards a high release of PFH during cardiopulmonary bypass was more pronounced, but the overall association between age and PFH levels was of borderline significance (P = 0.077). The correlation between PFH and post-operative serum creatinine was low and non-significant, but the latter correlated highly with the pre-operative serum creatinine values (Spearman's correlation coefficient reached values of 0.6-0.7, P < 0.001). Patients were classified according to the Risk of renal failure, Injury to the kidney, Failure of kidney function, Loss of kidney function and End-stage renal failure (RIFLE) classification for acute renal dysfunction during post-operative days 1 - 4; the influence of PFH levels at t(1) on the consequent RIFLE classification was not proven (P=0.648), but 4 patients in the Injury category had shown a higher median value of PFH (433.6 mg/L) in comparison with the others (29 patients with no acute renal dysfunction - 313.7 mg/L, 10 patients at Risk - 330.1 mg/L).

• MeSH
• akutní poškození ledvin krev   patologie   MeSH
• hemoglobiny metabolismus   MeSH
• kardiopulmonální bypass škodlivé účinky   MeSH
• kritický stav MeSH
• ledviny patofyziologie   MeSH
• lidé MeSH
• míra přežití MeSH
• prognóza MeSH
• prospektivní studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• srdeční chlopně patofyziologie   chirurgie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• hemoglobiny MeSH