Increase of bradykinin in plasma of patients undergoing cardiopulmonary bypass

The importance of lung exclusion

Massimo Cugno, Jürg Nussberger, Paolo Biglioli, Francesco Alamanni, Raffaella Coppola, Angelo Agostoni

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Study objectives: Hemodynamic complications including hypotensive episodes are frequently associated with cardiopulmonary bypass (CPB) and can be attributed to a generalized inflammatory response in which bradykinin may be a mediator. The purpose of this study was to determine the plasma levels of bradykinin-(1-9)nonapeptide in patients during CPB and the physiologic elimination of bradykinin by the lungs. Design: Prospective, observational study. Setting: University hospital, cardiac surgery unit. Patients and methods: Intra-arterial BP was monitored and serial blood samples were obtained from 27 patients undergoing CPB for cardiac surgery. We measured plasma bradykinin and parameters of coagulation, fibrinolysis, complement, contact system, and the cytokine tumor necrosis factor (TNF). Results: Mean arterial pressure fell progressively until the end of CPB (- 18 mm Hg, p = 0.001) but returned to baseline by the end of surgery. The venous bradykinin level, normal in basal conditions (median, 1.90 fmol/mL), was increased (p = 0.001) from 15 min after the beginning of CPB (5.71 fmol/mL) to the end of the operation (7.07 fmol/mL), with a peak at the end of CPB (9.81 fmol/mL; p = 0.0001); it was normal at recovery 24 h later (2.81 fmol/mL). Bradykinin plasma levels fell 60% across the lung when the pulmonary circulation was fully restored while the patients were still receiving CPB. Activated-factor XII, thrombin-antithrombin complexes, prothrombin fragment F1 + 2, plasmin-antiplasmin complexes, C3a, and TNF increased significantly after the beginning of the surgical procedure, rising further during CPB, and remained elevated until the end of surgery, but they all returned to normal within 24 h. Changes in plasma bradykinin levels were not correlated with any of the other variables. Conclusions: During CPB, there is a progressive increase of plasma bradykinin that is at least partially due to reduced catabolism as a consequence of shunting the lungs. The increase in bradykinin may contribute to the fall in BP.

Original languageEnglish
Pages (from-to)1776-1782
Number of pages7
JournalChest
Volume120
Issue number6
DOIs
Publication statusPublished - 2001

Fingerprint

Bradykinin
Cardiopulmonary Bypass
Lung
Thoracic Surgery
Tumor Necrosis Factor-alpha
Factor XIIa
Antifibrinolytic Agents
Pulmonary Circulation
Fibrinolysin
Fibrinolysis
Observational Studies
Arterial Pressure
Hemodynamics
Prospective Studies
Cytokines

Keywords

  • Angiotensin-converting enzyme
  • Bradykinin metabolism
  • Coagulation
  • Complement
  • Extracorporeal circulation
  • Fibrinolysis
  • Hypotension

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Increase of bradykinin in plasma of patients undergoing cardiopulmonary bypass : The importance of lung exclusion. / Cugno, Massimo; Nussberger, Jürg; Biglioli, Paolo; Alamanni, Francesco; Coppola, Raffaella; Agostoni, Angelo.

In: Chest, Vol. 120, No. 6, 2001, p. 1776-1782.

Research output: Contribution to journalArticle

Cugno, Massimo ; Nussberger, Jürg ; Biglioli, Paolo ; Alamanni, Francesco ; Coppola, Raffaella ; Agostoni, Angelo. / Increase of bradykinin in plasma of patients undergoing cardiopulmonary bypass : The importance of lung exclusion. In: Chest. 2001 ; Vol. 120, No. 6. pp. 1776-1782.
@article{2ef88e2df22d4f5e8edb1db4cb9bd8c0,
title = "Increase of bradykinin in plasma of patients undergoing cardiopulmonary bypass: The importance of lung exclusion",
abstract = "Study objectives: Hemodynamic complications including hypotensive episodes are frequently associated with cardiopulmonary bypass (CPB) and can be attributed to a generalized inflammatory response in which bradykinin may be a mediator. The purpose of this study was to determine the plasma levels of bradykinin-(1-9)nonapeptide in patients during CPB and the physiologic elimination of bradykinin by the lungs. Design: Prospective, observational study. Setting: University hospital, cardiac surgery unit. Patients and methods: Intra-arterial BP was monitored and serial blood samples were obtained from 27 patients undergoing CPB for cardiac surgery. We measured plasma bradykinin and parameters of coagulation, fibrinolysis, complement, contact system, and the cytokine tumor necrosis factor (TNF). Results: Mean arterial pressure fell progressively until the end of CPB (- 18 mm Hg, p = 0.001) but returned to baseline by the end of surgery. The venous bradykinin level, normal in basal conditions (median, 1.90 fmol/mL), was increased (p = 0.001) from 15 min after the beginning of CPB (5.71 fmol/mL) to the end of the operation (7.07 fmol/mL), with a peak at the end of CPB (9.81 fmol/mL; p = 0.0001); it was normal at recovery 24 h later (2.81 fmol/mL). Bradykinin plasma levels fell 60{\%} across the lung when the pulmonary circulation was fully restored while the patients were still receiving CPB. Activated-factor XII, thrombin-antithrombin complexes, prothrombin fragment F1 + 2, plasmin-antiplasmin complexes, C3a, and TNF increased significantly after the beginning of the surgical procedure, rising further during CPB, and remained elevated until the end of surgery, but they all returned to normal within 24 h. Changes in plasma bradykinin levels were not correlated with any of the other variables. Conclusions: During CPB, there is a progressive increase of plasma bradykinin that is at least partially due to reduced catabolism as a consequence of shunting the lungs. The increase in bradykinin may contribute to the fall in BP.",
keywords = "Angiotensin-converting enzyme, Bradykinin metabolism, Coagulation, Complement, Extracorporeal circulation, Fibrinolysis, Hypotension",
author = "Massimo Cugno and J{\"u}rg Nussberger and Paolo Biglioli and Francesco Alamanni and Raffaella Coppola and Angelo Agostoni",
year = "2001",
doi = "10.1378/chest.120.6.1776",
language = "English",
volume = "120",
pages = "1776--1782",
journal = "Chest",
issn = "0012-3692",
publisher = "Elsevier Inc.",
number = "6",

}

TY - JOUR

T1 - Increase of bradykinin in plasma of patients undergoing cardiopulmonary bypass

T2 - The importance of lung exclusion

AU - Cugno, Massimo

AU - Nussberger, Jürg

AU - Biglioli, Paolo

AU - Alamanni, Francesco

AU - Coppola, Raffaella

AU - Agostoni, Angelo

PY - 2001

Y1 - 2001

N2 - Study objectives: Hemodynamic complications including hypotensive episodes are frequently associated with cardiopulmonary bypass (CPB) and can be attributed to a generalized inflammatory response in which bradykinin may be a mediator. The purpose of this study was to determine the plasma levels of bradykinin-(1-9)nonapeptide in patients during CPB and the physiologic elimination of bradykinin by the lungs. Design: Prospective, observational study. Setting: University hospital, cardiac surgery unit. Patients and methods: Intra-arterial BP was monitored and serial blood samples were obtained from 27 patients undergoing CPB for cardiac surgery. We measured plasma bradykinin and parameters of coagulation, fibrinolysis, complement, contact system, and the cytokine tumor necrosis factor (TNF). Results: Mean arterial pressure fell progressively until the end of CPB (- 18 mm Hg, p = 0.001) but returned to baseline by the end of surgery. The venous bradykinin level, normal in basal conditions (median, 1.90 fmol/mL), was increased (p = 0.001) from 15 min after the beginning of CPB (5.71 fmol/mL) to the end of the operation (7.07 fmol/mL), with a peak at the end of CPB (9.81 fmol/mL; p = 0.0001); it was normal at recovery 24 h later (2.81 fmol/mL). Bradykinin plasma levels fell 60% across the lung when the pulmonary circulation was fully restored while the patients were still receiving CPB. Activated-factor XII, thrombin-antithrombin complexes, prothrombin fragment F1 + 2, plasmin-antiplasmin complexes, C3a, and TNF increased significantly after the beginning of the surgical procedure, rising further during CPB, and remained elevated until the end of surgery, but they all returned to normal within 24 h. Changes in plasma bradykinin levels were not correlated with any of the other variables. Conclusions: During CPB, there is a progressive increase of plasma bradykinin that is at least partially due to reduced catabolism as a consequence of shunting the lungs. The increase in bradykinin may contribute to the fall in BP.

AB - Study objectives: Hemodynamic complications including hypotensive episodes are frequently associated with cardiopulmonary bypass (CPB) and can be attributed to a generalized inflammatory response in which bradykinin may be a mediator. The purpose of this study was to determine the plasma levels of bradykinin-(1-9)nonapeptide in patients during CPB and the physiologic elimination of bradykinin by the lungs. Design: Prospective, observational study. Setting: University hospital, cardiac surgery unit. Patients and methods: Intra-arterial BP was monitored and serial blood samples were obtained from 27 patients undergoing CPB for cardiac surgery. We measured plasma bradykinin and parameters of coagulation, fibrinolysis, complement, contact system, and the cytokine tumor necrosis factor (TNF). Results: Mean arterial pressure fell progressively until the end of CPB (- 18 mm Hg, p = 0.001) but returned to baseline by the end of surgery. The venous bradykinin level, normal in basal conditions (median, 1.90 fmol/mL), was increased (p = 0.001) from 15 min after the beginning of CPB (5.71 fmol/mL) to the end of the operation (7.07 fmol/mL), with a peak at the end of CPB (9.81 fmol/mL; p = 0.0001); it was normal at recovery 24 h later (2.81 fmol/mL). Bradykinin plasma levels fell 60% across the lung when the pulmonary circulation was fully restored while the patients were still receiving CPB. Activated-factor XII, thrombin-antithrombin complexes, prothrombin fragment F1 + 2, plasmin-antiplasmin complexes, C3a, and TNF increased significantly after the beginning of the surgical procedure, rising further during CPB, and remained elevated until the end of surgery, but they all returned to normal within 24 h. Changes in plasma bradykinin levels were not correlated with any of the other variables. Conclusions: During CPB, there is a progressive increase of plasma bradykinin that is at least partially due to reduced catabolism as a consequence of shunting the lungs. The increase in bradykinin may contribute to the fall in BP.

KW - Angiotensin-converting enzyme

KW - Bradykinin metabolism

KW - Coagulation

KW - Complement

KW - Extracorporeal circulation

KW - Fibrinolysis

KW - Hypotension

UR - http://www.scopus.com/inward/record.url?scp=0035684295&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0035684295&partnerID=8YFLogxK

U2 - 10.1378/chest.120.6.1776

DO - 10.1378/chest.120.6.1776

M3 - Article

VL - 120

SP - 1776

EP - 1782

JO - Chest

JF - Chest

SN - 0012-3692

IS - 6

ER -