Intensive Care Medicine

, Volume 34, Issue 7, pp 1216–1223 | Cite as

Elevated pulmonary dead space and coagulation abnormalities suggest lung microvascular thrombosis in patients undergoing cardiac surgery

  • Barry Dixon
  • Duncan J. Campbell
  • John D. Santamaria
Original

Abstract

Objective

Inflammation has been shown to trigger microvascular thrombosis. Patients undergoing cardiac surgery sustain significant inflammatory insults to the lungs and in addition are routinely given anti-fibrinolytic agents to promote thrombosis. In view of these risk factors we investigated if evidence of pulmonary microvascular thrombosis occurs following cardiac surgery and, if so, whether a pre-operative heparin infusion may limit this.

Design

Double-blind randomised controlled trial.

Setting

Tertiary university affiliated hospital.

Patients

Twenty patients undergoing elective cardiac surgery.

Interventions

Patients were randomised to receive a pre-operative heparin infusion or placebo. All patients were administered aprotinin.

Measurements and results

Pulmonary microvascular obstruction was estimated by measuring the alveolar dead-space fraction. Pulmonary coagulation activation was estimated by measuring the ratio of prothrombin fragment levels in radial and pulmonary arterial blood. Systemic tissue plasminogen activator (t-PA) levels were also assessed. In the placebo group cardiac surgery triggered increased alveolar dead-space fraction levels and the onset of prothrombin fragment production in the pulmonary circulation. Administration of pre-operative heparin was associated with a lower alveolar dead-space fraction (p < 0.05) and reduced prothrombin fragment production in the pulmonary circulation (p < 0.05). Pre-operative heparin also increased baseline t-PA levels (p < 0.05).

Conclusion

The changes in the alveolar dead-space fraction and pulmonary coagulation activation suggest that pulmonary microvascular thrombosis develops during cardiac surgery and this may be limited by a pre-operative heparin infusion.

Keywords

Cardiopulmonary bypass Coagulation Fibrinolysis Inflammation Thrombosis 

Supplementary material

134_2008_1042_MOESM1_ESM.doc (46 kb)
Electronic Supplementary Material (DOC 46K)

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Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Barry Dixon
    • 1
  • Duncan J. Campbell
    • 2
  • John D. Santamaria
    • 1
  1. 1.Intensive Care UnitSt. Vincent’s HospitalMelbourneAustralia
  2. 2.St. Vincent’s Institute of Medical ResearchMelbourneAustralia

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