RESUMO
ABSTRACT: Cardiac surgery with cardiopulmonary bypass (CPB) is associated with an immune paresis that predisposes to the development of postoperative infections and sepsis. Among factors responsible for CPB-induced immunosuppression, circulating myeloid-derived suppressor cells (MDSCs) have been found to induce early lymphocyte apoptosis and lymphocyte proliferation inhibition. However, the mechanisms involved are not fully understood. In this study, we found that the main lymphocyte subsets decreased significantly 24 h after cardiac surgery with CBP. As expected, cardiac surgery with CPB induced a monocytic MDSC expansion associated with an increased T-cell apoptosis and decreased proliferation capacity. Noteworthy, granulocytic MDSCs remain stable. Myeloid-derived suppressor cell depletion restored the ability of T-cell to proliferate ex vivo . After CPB, indoleamine 2,3-dioxygenase activity and IL-10 plasma level were increased such as programmed death-ligand 1 monocytic expression, whereas plasma level of arginine significantly decreased. Neither the inhibition of indoleamine 2,3-dioxygenase activity nor the use of anti-programmed death-ligand 1 or anti-IL-10 blocking antibody restored the ability of T-cell to proliferate ex vivo . Only arginine supplementation restored partially the ability of T-cell to proliferate.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Células Supressoras Mieloides , Células Supressoras Mieloides/metabolismo , Ponte Cardiopulmonar/efeitos adversos , Indolamina-Pirrol 2,3,-Dioxigenase/metabolismo , Linfócitos/metabolismo , Ativação Linfocitária , Arginina , Proliferação de CélulasRESUMO
Emergent implantation of temporary mechanical circulatory support using venoarterial ECMO (ECLS for extracorporeal Life Support) is increasingly adopted in various indications of acute circulatory failure refractory to optimal medical treatment. To implant such devices, but also to provide appropriate daily management, expertise and adapted technical platform are required. Organization, coordination and regulation of such program are not clearly established in our country. We propose a dedicated territorial organization to improve and facilitate management of these specific and most severe patients.
Assuntos
Prestação Integrada de Cuidados de Saúde/normas , Oxigenação por Membrana Extracorpórea/normas , Avaliação de Processos e Resultados em Cuidados de Saúde/normas , Choque/terapia , Doença Aguda , Consenso , Prestação Integrada de Cuidados de Saúde/organização & administração , Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/instrumentação , Oxigenação por Membrana Extracorpórea/mortalidade , França , Humanos , Modelos Organizacionais , Avaliação de Processos e Resultados em Cuidados de Saúde/organização & administração , Equipe de Assistência ao Paciente/normas , Choque/diagnóstico , Choque/mortalidade , Choque/fisiopatologia , Resultado do TratamentoRESUMO
Leptospirosis is one of the most common pathogens responsible for life-threatening tropical disease in travelers. We report a case of massive intra-alveolar hemorrhage caused by Leptospira serovar Djasiman in a 38-year-old man returning from Laos, who was cured with antibiotics and salvage treatment with extra-corporeal membrane oxygenation.