NDLI: Dysfunction of alveolar macrophages after cardiac surgery and postoperative pneumonia?

Content Provider	Springer Nature : BioMed Central
Author	Chalk, Katharina Meisel, Christian Spies, Claudia Volk, Thomas Thuenemann, Karin Linneweber, Jörg Wernecke, Klaus-Dieter Sander, Michael
Abstract	Introduction Patients undergoing cardiac surgery have an increased risk of postoperative pneumonia. Pulmonary immune dysfunction might be a contributing factor. We therefore determined changes of the surface molecules on alveolar macrophages (AMs). To characterize modulation in patients with pneumonia we correlated these changes to the development of postoperative pneumonia. Methods After ethical approval and written informed consent, 33 patients undergoing elective coronary bypass grafting surgery were included in this observational study. Peripheral blood cells and alveolar lavage fluid were collected directly after induction of anesthesia and two hours after separation from cardiopulmonary bypass (CPB). Human leukocyte antigen-DR (HLA-DR) and toll-like receptors (TLR) 2/4 expression on monocytes and AM were assessed by flow cytometry. A total of three patients developed postoperative pneumonia determined according to the criteria of the Center of Disease Control. Statistical analysis was performed with the Mann–Whitney-U test and Wilcoxon test. Results We found significant changes of phenotypic and functional immune markers on AMs after cardiac surgery. HLA-DR expression on peripheral blood monocytes and AMs was significantly reduced compared to baseline in all patients (each approximately 30%). After surgery patients who developed postoperative pneumonia revealed a trend of stronger reduction of HLA-DR expression (83.7% versus 27.1%) and TLR4 expression on AMs (46.1% versus 9.9%) compared to patients without pneumonia. Already before surgery, the baseline of TLR2 expression on AM was significantly lower (27.7%) in patients who developed postoperative pneumonia. Conclusions As far as we know this is the first study that shows an early impairment of lung cellular immune response after cardiac surgery. These findings can help to understand the role of cell-mediated immunosuppression and its association to the development of postoperative pneumonia.
Related Links	https://ccforum.biomedcentral.com/counter/pdf/10.1186/cc13148.pdf
Ending Page	9
Page Count	9
Starting Page	1
File Format	HTM / HTML
ISSN	13648535
DOI	10.1186/cc13148
Journal	Critical Care
Issue Number	6
Volume Number	17
Language	English
Publisher	BioMed Central
Publisher Date	2013-12-09
Access Restriction	Open
Subject Keyword	Intensive Critical Care Medicine Emergency Medicine Chronic Obstructive Pulmonary Disease Chronic Obstructive Pulmonary Disease Patient TLR4 Expression Nosocomial Pneumonia Peripheral Blood Monocyte
Content Type	Text
Resource Type	Article
Subject	Critical Care and Intensive Care Medicine
Journal Impact Factor	8.8/2023
5-Year Journal Impact Factor	10.4/2023

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