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Analysis of the efficacy of leukocyte depleting filters during cardiopulmonary bypass / by Chelsea Starrett.

by Starrett, Chelsea.

Leukocyte Reduction Procedures -- instrumentation.

Neutrophil Activitation

Systemic Inflammatory Response Syndrome -- prevention & control

Cardiopulmonary bypass -- Adverse effects

100 leaves : ill. ; 29 cm.

Thesis advisor: Dr. Ron Gerrits.

Committee members: Dr. Larry Fennigkoh, Kirsten Kallies.

Introduction -- Background -- SIRS associated with CPB -- Mechanisms of leukocyte depletion -- Methods and strategies of leukocyte filtration -- Hypothesis -- Methods of analysis -- Results - Discussion -- Conclusions and recommendations -- A: Suggested study parameters -- B: Aurora IRB exemption approval form.

The systemic inflammatory response (SIR) is activated through the usage of cardiopulmonary bypass (CPB) during cardiovascular surgery. This response is mediated by leukocyte activation, mainly neutrophils. Recently, leukocyte depletion filters (LDFs) have been designed to be incorporated into the bypass circuit to reduce the effect of inflammatory activation. Although some studies have shown this method to be effective, there are several other studies that do not show any benefit. The aim of this paper is to evaluate the existing literature in order to determine the efficacy of LDF utilization during CPB surgery.

This paper reviews available information on LDF usage. This includes the placement of filters in the arterial, venous, and/or cardioplegia systems, as well as the timing of such usages. The focus of this literature review was on the modulatory effects of LDFs in regards to markers of systemic inflammation and its influence on patient outcomes. The hypothesis tested in this study was that the use of LDFs correlates with politive clinical outcomes by attenuating the SIR.

A careful review of the existing research, evidence shows that the markers of inflammation decrease and clinical outcomes improve. This review found a majority of studies showed that LDFs improve patient outcomes and decrease the markers of SIRS especially when LDFs are used strategically in the arterial line. Studies that demonstrated no improvements simply showed no effect versus negative outcomes. However, published studies are inconsistent in filter usage/timing and tracked clinical outcomes. Therefore, these factors add complixity to evaluate.This situation is compounded by the individual pathologies of the patient being treated, surgical techniques, and perfusion management. Therefore, maximal effectiveness must be determined by the protocols of the surgical team, the amount and length of depletion necessary to have effect, and the placement of the filter in the CPB circuit. Therefore, filtration may need to be individualized to the institution and the surgical team.

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