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Eur J Cardiothorac Surg 2007;32:83-89. doi:10.1016/j.ejcts.2007.04.011
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

A single prophylactic dose of pentoxifylline reduces high dependency unit time in cardiac surgery — a prospective randomized and controlled study

^a Department of Anaesthesiology, University of Luebeck, Luebeck, Germany
^b Department of Anaesthesiology, Catholic Hospital Association Weser-Egge, Höxter, Germany
^c Department of Cardiac Surgery, University of Luebeck, Luebeck, Germany

Received 2 January 2007; received in revised form 31 March 2007; accepted 3 April 2007.

^_* Corresponding author. Address: Department of Anaesthesiology, University of Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany. Tel.: +49 451 500 4057; fax: +49 451 500 3407. (Email: Hermannheinze{at}ngi.de).

Background: The pathogenesis of the post cardiopulmonary bypass (CPB) organ dysfunction syndrome is complex, with inflammation being an important component. The purpose of this prospective, randomized and controlled study was to evaluate the effect of a single dose of pentoxifylline (PTX) prior to CPB on high dependency unit time. Materials and methods: We studied 39 patients undergoing aorto-coronary bypass surgery with CPB. Patients received either 5 mg kg^–1 PTX after induction of anaesthesia or saline as placebo. Haemodynamics, parameters of pulmonary function and plasma levels of tumour necrosis factor (TNF) and C-reactive protein (CRP) were measured after the induction of anaesthesia (pre-CPB) and after weaning from CPB (post-CPB), 1 h after the admission to the intensive care unit (ICU) and on the morning of the first postoperative day (1 POD), respectively. In addition, ventilation time and the high dependency unit time, i.e. the time till transferral to a peripheral ward, were documented. Results: Patients in the PTX group had lower TNF values (6.3 ng ml^–1 (4/8.2) vs 9.1 ng ml^–1 (6.5/13.7)) (median (25%/75%), p = 0.021), lower systolic (28 ± 7 mmHg vs 35 ± 9 mmHg, mean ± SD, p = 0.011) and mean pulmonary artery pressures (21 ± 5 vs 26 ± 6 mmHg, p = 0.017) after admission to the ICU than control patients. Haemodynamics and pulmonary function parameters did not differ. There was a trend towards earlier weaning from the respirator in the PTX group (10.0 ± 3.5 h) (min/max: 4/16; confidence interval (ConF): 1.8 h) than the control group (12.3 ± 4.2 h) (min/max: 5–24; ConI: 2.4 h) (p = 0.077). Patients treated with PTX could be transferred to a peripheral ward about 24 h earlier than control patients (95 ± 35 h, min/max: 32/190 h; ConI: 17 h; 119 ± 29 h, min/max: 66/165 h; ConI: 16 h) respectively; p = 0.037). Conclusion(s): A single dose of PTX prior to CPB was able to reduce plasma levels of TNF. In this descriptive study, there was a trend towards reduced duration of ventilation and the high dependency unit time, i.e. the time till transferral to a peripheral ward was shortened.

Key Words: Cardiopulmonary bypass • Cardiac surgery • Systemic inflammatory response • Pentoxifylline • Lung

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