Prime leukocyte filtration combined with conventional ultrafiltration in paediatric cardiopulmonary bypass

Leszek Bęc, Maciej A. Karolczak

Summary
Background. Cardiopulmonary bypass (CPB) results in development of a systemic inflamatory response. Preventing ”post-pump” syndrome during surgery improves the postoperative recovery of patients. We sought to compare conventional ultrafiltration (CUF) and prime leukocyte filtration in paediatric patients operated on for congenital heart defects using CPB.
Methods. 40 paediatric patients were divided into three groups: prime leukocyte filtration (n=10), prime leukocyte filtration combined with conventional ultrafiltration (n=10), and a control group (n=20) with no filtration or CUF used. The arterial blood samples were obtained after induction of anaesthesia, after commencing CPB, and 1 hour and 24 hours after surgery. The levels of proinflamatory interleukin-6 (IL-6), interleukin-8 (IL-8) and tumour necrosis factor-alpha (TNFα) were measured and compared with postoperative findings. The ultrafiltration supernatant was sampled to determine the content of cytokines.
Results. We found no cytokines in the supernatant. The levels of IL-6, IL-8 were significantly higher in the ultrafiltration group compared with leukocyte filtration and control groups. The plasma levels on TNFα were also elevated, with no statistical differences between groups, however. The higher levels of cytokines were associated with increased total blood loss and a higher number of patients with pleural effusions as well.
Conclusion: The machanism of conventional ultrafiltration is not cytokine elimination. High plasma levels of proinflamatory cytokines augment total blood loss and pleural effusions in patients treated with conventional ultrafiltration. The use of leukocyte filters improves renal function, and diminishes the risk of pleural effusions in paediatric patients operated on with the use of a cardiopulmonary bypass.

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