Hypothesis: Aortic surgery results in ischemia-reperfusion injury that induces an inflammatory response and frequent complications. The magnitude of the inflammatory response in blood and bronchi may be associated with the risk of immediate complications.
Objectives: To evaluate bronchial microdialysis as a continuous monitoring of cytokines in bronchial epithelial lining fluid (ELF) and to determine whether bronchial ELF cytokine levels reflect the ischemia-reperfusion injury and risk for complications during open abdominal aortic aneurysm (AAA) repair. We measured cytokines in venous blood using microdialysis and in serum for comparison.
Methods: Sixteen patients scheduled for elective open AAA repair were included in a prospective observational study. Microdialysis catheters were introduced into a bronchi and a cubital vein. Eighteen cytokines were measured using a Bio-Plex Magnetic Human Cytokine Panel.
Measurements and Main Results: Samples were collected before and during cross-clamping of the aorta as well as from 0-60 min and from 60-120 min of reperfusion. The ELF levels of IL-5, IL-6, IL-13, GM-CSF, IL-2, IL-4 and TNF-α increased, whereas IL-7 decreased during reperfusion. Venous levels of IL-1β, IL-4, IL-6, IL-8, IL-10, IL-12, IL-17, MCP-1, MIP-1α, MIP-1β and TNF-α increased and exhibited their highest concentration during reperfusion. Both bronchial and venous cytokine levels correlated with duration of the procedure, critical care days and preoperative kidney disease. Three patients suffered organ failure as a direct consequence of the procedure, and in these patients the bronchial ELF concentrations of seventeen out of 18 cytokines differed significantly from patients without such complications.
Conclusions: Bronchial microdialysis is suited for continuous monitoring of inflammation during open AAA repair. The bronchial ELF cytokine levels may be useful in predictin
