Elevated free fatty acid level is a risk factor for early postoperative hypoxemia after on-pump coronary artery bypass g
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RESEARCH ARTICLE
Open Access
Elevated free fatty acid level is a risk factor for early postoperative hypoxemia after on-pump coronary artery bypass grafting: association with endothelial activation Sheng Shi1, Yuan Gao2, Limin Wang1, Jian Liu1, Zhongxiang Yuan1* and Min Yu1*
Abstract Background: We aimed to investigate the relationship between increased free fatty acid (FFA) level and early postoperative hypoxemia after coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). Methods: Ninety-eight consecutive patients undergoing CABG were enrolled. Early postoperative hypoxemia was defined as the lowest of the ratio of arterial oxygen tension (PaO2) to inspired oxygen fraction (FiO2) ≤ 200 mm Hg within 24 h without pleural effusion and pneumothorax. The 26 perioperative factors, serum levels of FFA and inflammatory cytokines between the hypoxemia and non-hypoxemia groups were recorded or detected using autoanalyzer and enzyme-linked immunosorbent assay, respectively. Additionally, the risk factors for early postoperative hypoxemia were evaluated using multiple logistic regression analysis. Results: The incidence rate of early postoperative hypoxemia was 37.8 %. Serum FFA levels were significantly higher in the hypoxemia group than in the non-hypoxemia group (P < 0.001). Further, postoperative serum FFA levels were inversely related to the lowest of the ratio of PaO2/FiO2 at 24 h after CABG (r = − 0.367, P < 0.001). Multiple logistic regression analysis confirmed that age, body mass index and postoperative serum FFA concentrations were independently associated with early postoperative hypoxemia. Notably, patients with hypoxemia had markedly higher serum intercellular adhesion molecule-1 (ICAM-1) levels than those without (P < 0.001). Moreover, serum FFA levels at 2 h after CABG correlated positively with ICAM-1 concentrations (r = 0.492, P < 0.001). Conclusions: Elevated FFA concentration is a risk factor for early postoperative hypoxemia after on-pump CABG, which may be closely associated with endothelial activation. Keywords: Free fatty acid, Coronary artery bypass grafting, Hypoxemia, Cardio- pulmonary bypass, Mechanism
Background Coronary artery bypass surgery has traditionally been performed with cardiopulmonary bypass (CPB). Coronary artery bypass grafting (CABG) with CPB could result in systemic inflammatory response, lung ischemia-reperfusion injury, blood transfusion and surgery procedure and further cause a series of pathophysiological changes of lung injury * Correspondence: [email protected]; [email protected] Sheng Shi and Yuan Gao are co-first authors. 1 Department of Cardiovascular Surgery, Shanghai First People’s Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Shanghai 200080, P.R. China Full list of author information is available at the end of the article
including pulmonary edema, decreased lung compliance, disturbance of ventilation-perfusion ratio and increased pulmonary vascular resistance, finally leading to postoperative hypoxemia [1–3]. P
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