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Doctoral Thesis
DOI
https://doi.org/10.11606/T.5.2011.tde-14062011-153309
Document
Author
Full name
Rodrigo Sanchez Veliz
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2011
Supervisor
Committee
Malbouisson, Luiz Marcelo Sá (President)
Braz, José Reinaldo Cerqueira
Ferez, David
Otsuki, Denise Aya
Torres, Marcelo Luis Abramides
Title in Portuguese
Efeitos imediatos da circulação extracorpórea sobre o sistema mucociliar
Keywords in Portuguese
Anestesia cardiotorácica
Circulação extracorpórea
Cirurgia torácica
Depuração mucociliar
Abstract in Portuguese
INTRODUÇÃO: A circulação extracorpórea (CEC) é um fator etiológico importante para a lesão pulmonar, observada após cirurgia cardíaca. No entanto, o impacto da CEC na função mucociliar respiratória é desconhecido. O objetivo do estudo foi avaliar os efeitos imediatos da CEC sobre o sistema de transporte mucociliar. MÉTODOS: 22 porcos mestiços das raças Large White e Landrace com peso entre 33 a 47 kg alocados nos grupos controle (n = 10) e CEC (n = 12) completaram o estudo. As técnicas de anestesia e ventilação mecânica foram padronizadas. Após a indução da anestesia, foi realizada traqueostomia e uma amostra do tecido traqueal foi excisado (T0) em ambos os grupos. Todos os animais foram submetidos a toracotomia e CEC aorto-bicaval foi instalada no grupo CEC e mantida durante 90 minutos. Após o desmame da CEC (T90), uma segunda amostra do tecido traqueal foi obtida 180 minutos após a traqueostomia (T180). Amostras de muco foram coletadas na traquéia por meio de broncoscopia em T0, T90 e T180. Frequência de batimento ciliar (FBC) e transporte mucociliar in situ (TMC) foram estudados em epitélio traqueal ex vivo. As características do muco respiratório in vitro foram estudadas por transportabilidade ciliar no palato de rã (VTM), Transporte do muco respiratório in vitro pela tosse (TMT), Ângulo de contato (AC) e da viscosidade do muco por viscosímetro Cone-Plate (VM). RESULTADOS: A FBC diminuiu no grupo CEC (13,09 ± 1,91 Hz vs 11,06 ± 2,1 Hz, p <0,05), mas não no grupo controle (13,42 ± 0,96 Hz vs 12, 98 ± 2,84 Hz). No momento T90, a viscosidade aparente avaliado em 100 RPM estava aumentada no grupo CEC em relação ao controle. Não foram observadas diferenças significativas no TMC, VTM, TMT e AC. No grupo de CEC, foi percebida a perda do epitélio ciliado, edema submucoso e infiltração de células inflamatórias na avaliação histológica da traqueia. CONCLUSÃO: A CEC compromete agudamente o sistema de transporte mucociliar traqueal. Novos estudos são necessários para avaliar se esse comportamento tem implicações clínicas
Title in English
Immediate effects of cardiopulmonary bypass on mucociliary system
Keywords in English
Cardiopulmonary bypass
Cardiothoracic anesthesia
Mucociliary clearance
Thoracic surgery
Abstract in English
BACKGROUND: Cardiopulmonary bypass (CPB) is an important etiologic factor for lung injury observed after cardiac surgery. However, the impact of CPB on respiratory mucociliary function is unknown. The objective of this study was to assess the immediate effects of CPB on mucociliary transport system. METHODS: Twenty-two mixed breed of Large White and Landrace pigs with weight between 33 to 47kg assigned to control (n=10) and CPB groups (n=12) completed the study. The techniques of anesthesia and mechanical ventilation were standardized. After anesthesia induction, tracheotomy was performed and a tracheal tissue sample was excised (T0) in both groups. All animals underwent thoracotomy and aorto-bicaval CPB was installed in CPB group and maintained during 90 minutes. After weaning from CPB (T90), a second tracheal tissue sample was obtained 180 minutes after tracheotomy (T180). Mucus samples were collected from the trachea using a bronchoscope at T0, T90 and T180. Ciliary beat frequency (CBF) and in situ mucociliary transport (MCT) were studied in ex vivo tracheal epithelium. In vitro respiratory mucus characteristics were studied by mucociliary transportability in frog palate (MT), Cough clearance (CC), Contact angle (CA) and the mucus viscosity by Cone-Plate viscometer (MV). RESULTS: CBF decreased in CPB group (13.09 ± 1.91 Hz vs. 11.06 ± 2.1 Hz, p < 0.05) but not in control group (13.42 ± 0.96 Hz vs. 12.98 ± 2.84 Hz). At T90 Apparent viscosity evaluated at 100 RPM increased in CPB group compared to control. No significant differences were observed in MCT, MT, CA and CC. In CPB group, it was observed loss of ciliated epithelia, submucosal edema and inflammatory cells infiltration in tracheal histology. CONCLUSION: CPB acutely compromise the tracheal mucociliary transport system. New studies are necessary to investigate if this behavior has any clinical implication
 
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Publishing Date
2011-06-20
 
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