Pharmacological interventions to reduce edema following cardiopulmonary bypass: A systematic review and meta-analysis

Research output: Contribution to journalReview articleAcademicpeer-review

Abstract

PURPOSE: To compare the effectiveness of different types of pharmacological agents to reduce organ specific edema following cardiopulmonary bypass (CPB).

METHODS: Pubmed, Embase.com and Cochrane were searched for studies administrating a pharmacological agent before CPB. Primary outcome was postoperative edema.

RESULTS: Forty-four studies (clinical n = 6, preclinical n = 38) fulfilled eligibility criteria. Steroids were used in most clinical studies (n = 5, 83%) and reduced postoperative edema in 4 studies, however heterogeneity precluded meta-analysis. In preclinical studies, a total of 31 different drugs were tested of which 20 (65%) reduced edema in at least one organ. Particularly neutrophil inhibitors, and modulators of coagulation or endothelial barrier reduced pulmonary edema (SMD -2.77 [-3.93, -1.61]; -1.29 [-2.12, -0.46], -2.33 [-4.69, 0.03], respectively) compared to no treatment. Reducing renal (SMD -0.91 [CI -1.65 to -0.18]), intestinal (SMD -1.98 [CI -3.92 to -0.04]) or myocardial (SMD -1.95 [CI -3.91 to -0.01]) edema following CPB required specific modulators of endothelial barrier.

CONCLUSION: Overall, neutrophil inhibitors and direct modulators of endothelial barrier (PAR1, Tie2 signaling) most effectively reduced edema following CPB, in particular pulmonary edema. Future research should focus on a combination of these strategies to reduce edema and assess the effect on organ function and outcome following CPB.

Original languageEnglish
Pages (from-to)63-72
Number of pages10
JournalJournal of Critical Care
Volume56
Early online date10 Dec 2019
DOIs
Publication statusPublished - 2020

Cite this

@article{da1a9231515b42338cdad64ffbf5d9e5,
title = "Pharmacological interventions to reduce edema following cardiopulmonary bypass: A systematic review and meta-analysis",
abstract = "PURPOSE: To compare the effectiveness of different types of pharmacological agents to reduce organ specific edema following cardiopulmonary bypass (CPB).METHODS: Pubmed, Embase.com and Cochrane were searched for studies administrating a pharmacological agent before CPB. Primary outcome was postoperative edema.RESULTS: Forty-four studies (clinical n = 6, preclinical n = 38) fulfilled eligibility criteria. Steroids were used in most clinical studies (n = 5, 83{\%}) and reduced postoperative edema in 4 studies, however heterogeneity precluded meta-analysis. In preclinical studies, a total of 31 different drugs were tested of which 20 (65{\%}) reduced edema in at least one organ. Particularly neutrophil inhibitors, and modulators of coagulation or endothelial barrier reduced pulmonary edema (SMD -2.77 [-3.93, -1.61]; -1.29 [-2.12, -0.46], -2.33 [-4.69, 0.03], respectively) compared to no treatment. Reducing renal (SMD -0.91 [CI -1.65 to -0.18]), intestinal (SMD -1.98 [CI -3.92 to -0.04]) or myocardial (SMD -1.95 [CI -3.91 to -0.01]) edema following CPB required specific modulators of endothelial barrier.CONCLUSION: Overall, neutrophil inhibitors and direct modulators of endothelial barrier (PAR1, Tie2 signaling) most effectively reduced edema following CPB, in particular pulmonary edema. Future research should focus on a combination of these strategies to reduce edema and assess the effect on organ function and outcome following CPB.",
keywords = "Capillary permeability, Cardiac surgery, Cardiopulmonary bypass, Edema, Endothelium, Vascular leakage",
author = "Dekker, {Nicole A M} and {van Leeuwen}, {Anoek L I} and {van de Ven}, {Peter M} and {de Vries}, Ralph and Hordijk, {Peter L} and Christa Boer and {van den Brom}, {Charissa E}",
note = "Copyright {\circledC} 2019 The Authors. Published by Elsevier Inc. All rights reserved.",
year = "2020",
doi = "10.1016/j.jcrc.2019.12.006",
language = "English",
volume = "56",
pages = "63--72",
journal = "Journal of Critical Care",
issn = "0883-9441",
publisher = "Elsevier BV",

}

Pharmacological interventions to reduce edema following cardiopulmonary bypass : A systematic review and meta-analysis. / Dekker, Nicole A M; van Leeuwen, Anoek L I; van de Ven, Peter M; de Vries, Ralph; Hordijk, Peter L; Boer, Christa; van den Brom, Charissa E.

In: Journal of Critical Care, Vol. 56, 2020, p. 63-72.

Research output: Contribution to journalReview articleAcademicpeer-review

TY - JOUR

T1 - Pharmacological interventions to reduce edema following cardiopulmonary bypass

T2 - A systematic review and meta-analysis

AU - Dekker, Nicole A M

AU - van Leeuwen, Anoek L I

AU - van de Ven, Peter M

AU - de Vries, Ralph

AU - Hordijk, Peter L

AU - Boer, Christa

AU - van den Brom, Charissa E

N1 - Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.

PY - 2020

Y1 - 2020

N2 - PURPOSE: To compare the effectiveness of different types of pharmacological agents to reduce organ specific edema following cardiopulmonary bypass (CPB).METHODS: Pubmed, Embase.com and Cochrane were searched for studies administrating a pharmacological agent before CPB. Primary outcome was postoperative edema.RESULTS: Forty-four studies (clinical n = 6, preclinical n = 38) fulfilled eligibility criteria. Steroids were used in most clinical studies (n = 5, 83%) and reduced postoperative edema in 4 studies, however heterogeneity precluded meta-analysis. In preclinical studies, a total of 31 different drugs were tested of which 20 (65%) reduced edema in at least one organ. Particularly neutrophil inhibitors, and modulators of coagulation or endothelial barrier reduced pulmonary edema (SMD -2.77 [-3.93, -1.61]; -1.29 [-2.12, -0.46], -2.33 [-4.69, 0.03], respectively) compared to no treatment. Reducing renal (SMD -0.91 [CI -1.65 to -0.18]), intestinal (SMD -1.98 [CI -3.92 to -0.04]) or myocardial (SMD -1.95 [CI -3.91 to -0.01]) edema following CPB required specific modulators of endothelial barrier.CONCLUSION: Overall, neutrophil inhibitors and direct modulators of endothelial barrier (PAR1, Tie2 signaling) most effectively reduced edema following CPB, in particular pulmonary edema. Future research should focus on a combination of these strategies to reduce edema and assess the effect on organ function and outcome following CPB.

AB - PURPOSE: To compare the effectiveness of different types of pharmacological agents to reduce organ specific edema following cardiopulmonary bypass (CPB).METHODS: Pubmed, Embase.com and Cochrane were searched for studies administrating a pharmacological agent before CPB. Primary outcome was postoperative edema.RESULTS: Forty-four studies (clinical n = 6, preclinical n = 38) fulfilled eligibility criteria. Steroids were used in most clinical studies (n = 5, 83%) and reduced postoperative edema in 4 studies, however heterogeneity precluded meta-analysis. In preclinical studies, a total of 31 different drugs were tested of which 20 (65%) reduced edema in at least one organ. Particularly neutrophil inhibitors, and modulators of coagulation or endothelial barrier reduced pulmonary edema (SMD -2.77 [-3.93, -1.61]; -1.29 [-2.12, -0.46], -2.33 [-4.69, 0.03], respectively) compared to no treatment. Reducing renal (SMD -0.91 [CI -1.65 to -0.18]), intestinal (SMD -1.98 [CI -3.92 to -0.04]) or myocardial (SMD -1.95 [CI -3.91 to -0.01]) edema following CPB required specific modulators of endothelial barrier.CONCLUSION: Overall, neutrophil inhibitors and direct modulators of endothelial barrier (PAR1, Tie2 signaling) most effectively reduced edema following CPB, in particular pulmonary edema. Future research should focus on a combination of these strategies to reduce edema and assess the effect on organ function and outcome following CPB.

KW - Capillary permeability

KW - Cardiac surgery

KW - Cardiopulmonary bypass

KW - Edema

KW - Endothelium

KW - Vascular leakage

UR - http://www.scopus.com/inward/record.url?scp=85076374447&partnerID=8YFLogxK

U2 - 10.1016/j.jcrc.2019.12.006

DO - 10.1016/j.jcrc.2019.12.006

M3 - Review article

VL - 56

SP - 63

EP - 72

JO - Journal of Critical Care

JF - Journal of Critical Care

SN - 0883-9441

ER -