JUSTIFICATIVA E OBJETIVOS: A Síndrome da Resposta Inflamatória Sistêmica é uma ocorrência habitual em cirurgias cardíacas com circulação extracorpórea (CEC). O objetivo deste estudo foi avaliar os níveis sistêmicos e pulmonares de citocinas e a correlação com a função pulmonar em pacientes submetidos à revascularização miocárdica (RM) com CEC. MÉTODOS: O estudo foi aprovado pela Comissão de Ética institucional, com a avaliação de 13 pacientes submetidos à RM com CEC. Após a indução anestésica, ao término da CEC, realizaram-se dosagens plasmáticas e no lavado broncoalveolar de IL-1β, IL-6, IL-8, IL-10 e TNF-α. Foram avaliados o tempo de CEC e de cirurgia, a relação PaO2/FiO2, o gradiente alvéolo-arterial de oxigênio (GA-aO2), o shunt e a complacência pulmonares. Os resultados foram submetidos à análise de variância para medidas repetidas (*p < 0,05) e coeficiente de correlação de Spearman. RESULTADOS: Observaram-se aumento dos níveis de citocinas no plasma e no lavado broncoalveolar após a CEC e relação direta entre o aumento da IL-1β e a diminuição da complacência pulmonar (p = 0,0439), assim como relação inversa entre o aumento da IL-10 e a redução da complacência (p = 0,0325). O aumento da IL-6 teve relação direta com o tempo de CEC (p = 0,012), enquanto o aumento da IL-8 teve relação direta com o tempo de cirurgia (p < 0,0001). Os níveis de IL-1β, IL-8 e TNF-α foram maiores no LBA em relação ao plasma. CONCLUSÕES: Ocorre aumento dos níveis de citocinas no plasma e lavado broncoalveolar após a CEC e há correlação entre o aumento dos níveis de citocinas e o tempo de CEC e de cirurgia e as alterações na complacência pulmonar.

BACKGROUND AND OBJECTIVES: Systemic inflammatory response syndrome is commonly observed in coronary artery bypass grafts (CABG) with cardiopulmonary bypass (CB). The objective of this study was to evaluate the systemic and pulmonary levels of cytokines and their correlation with lung function in patients undergoing myocardial revascularization (MR) with CB. METHODS: This study was approved by the Institutional Ethics Committee, and 13 patients undergoing MR with CB were evaluated. After anesthetic induction and at the end of CB, plasma and bronchoalveolar lavage levels of IL-1β, IL-6, IL-8, IL-10, and TNF-α were determined. The dur ation of CB and surgery, PaO2/FiO2 ratio, alveolar-arterial oxygen gradient (A-a gradient), shunt, and lung compliance were evaluated. Results were submitted to analysis of variance for repeated measurements (*p < 0.05) and Spearman's correlation coefficient. RESULTS: We observed increased levels of cytokines in plasma and bronchoalveolar lavage after CB and a direct relationship between the increase in IL-1β and decrease in lung compliance (p = 0.0439), as well as the inverse relationship between the increase in IL-10 and a decrease in compliance (p = 0.0325). The increase in IL-6 was directly related to the duration of CB (p = 0.012), while the increase in IL-8 was directly related to the duration of surgery (p < 0.0001). Levels of interleukin-1β, IL-8, and TNF-α in bronchoalveolar lavage were higher than in plasma. CONCLUSIONS: There is an increase in cytokine levels in plasma and bronchoalveolar lavage after CB, as well as a correlation between increased cytokine levels and CB duration and surgery and changes in lung compliance.

JUSTIFICATIVA Y OBJETIVOS: El Síndrome de la Respuesta Inflamatoria Sistémica es algo habitual en las cirugías cardíacas con circulación extracorpórea (CEC). El objetivo de este estudio fue evaluar los niveles sistémicos y pulmonares de citocinas y la correlación con la función pulmonar en los pacientes sometidos a la revascularización miocárdica (RM) con CEC. MÉTODOS: El estudio fue aprobado por la Comisión de Ética Institucional, con la evaluación de 13 pacientes sometidos a la RM con CEC. Después de la inducción anestésica al término de la CEC, se realizaron dosificaciones plasmáticas y también en el lavado broncoalveolar de IL-1β, IL-6, IL-8, IL-10 y TNF-α. Se evaluaron el tiempo de CEC y de cirugía, la relación PaO2/FiO2, el gradiente alvéolo-arterial de oxígeno (GA-aO2), el shunt y la complacencia pulmonares. Los resultados fueron sometidos al análisis de variancia para medidas repetidas (*p < 0,05) y al coeficiente de correlación de Spearman. RESULTADOS: Se observó un aumento en los niveles de citocinas en el plasma y en el lavado broncoalveolar después de la CEC y una relación directa entre el aumento de la IL-1β y la disminución de la complacencia pulmonar (p = 0,0439), como también una relación inversa entre el aumento de la IL-10 y la reducción de la complacencia (p = 0,0325). El aumento de la IL-6 tuvo una relación directa con el tiempo de CEC (p = 0,012), mientras que el aumento de la IL-8 tuvo una relación directa con el tiempo de cirugía (p < 0,0001). Los niveles de IL-1β, IL-8 y TNF-α fueron mayores en el LBA con relación al plasma. CONCLUSIONES: Ocurre un aumento de los niveles de citocinas en el plasma y en el lavado broncoalveolar después de la CEC, con una correlación entre el aumento de los niveles de citocinas y el tiempo de CEC y de cirugía, y las alteraciones en la complacencia pulmonar.

INTRODUCTION: Common variable immunodeficiency is characterized by defective antibody production and recurrent pulmonary infections. Intravenous immunoglobulin is the treatment of choice, but the effects of Intravenous immunoglobulin on pulmonary defense mechanisms are poorly understood. OBJECTIVE: The aim of this study was to verify the impact of intravenous immunoglobulin on the physical properties of the sputum and on inflammatory alterations in the airways of patients with Common variable immunodeficiency associated with bronchiectasis. METHOD: The present study analyzed sputum physical properties, exhaled NO, inflammatory cells in the sputum, and IG titers in 7 patients with Common variable immunodeficiency and bronchiectasis with secretion, immediately before and 15 days after Intravenous immunoglobulin. A group of 6 patients with Common variable immunodeficiency and bronchiectasis but no sputum was also studied for comparison of the basal IgG level and blood count. The 13 patients were young (age=36±17 years) and comprised predominantly of females (n=11). RESULTS: Patients with secretion presented significantly decreased IgG and IgM levels. Intravenous immunoglobulin was associated with a significant decrease in exhaled NO (54.7 vs. 40.1 ppb, p<0.05), sputum inflammatory cell counts (28.7 vs. 14.6 cells/mm³, p<0.05), and a significant increase in respiratory mucus transportability by cough (42.5 vs. 65.0 mm, p < 0.05). CONCLUSION: We concluded that immunoglobulin administration in Common variable immunodeficiency patients results in significant improvement in indexes of inflammation of the airways with improvement in the transportability of the respiratory mucus by cough.

Acute respiratory distress syndrome (ARDS) is characterized by diffuse alveolar damage, and evolves progressively with three phases: exsudative, fibroproliferative, and fibrotic. In the exudative phase, there are interstitial and alveolar edemas with hyaline membrane. The fibroproliferative phase is characterized by exudate organization and fibroelastogenesis. There is proliferation of type II pneumocytes to cover the damaged epithelial surface, followed by differentiation into type I pneumocytes. The fibroproliferative phase starts early, and its severity is related to the patient’s prognosis. The alterations observed in the phenotype of the pulmonary parenchyma cells steer the tissue remodeling towards either progressive fibrosis or the restoration of normal alveolar architecture. The fibrotic phase is characterized by abnormal and excessive deposition of extracellular matrix proteins, mainly collagen. The dynamic control of collagen deposition and degradation is regulated by metalloproteinases and their tissular regulators. The deposition of proteoglycans in the extracellular matrix of ARDS patients needs better study. The regulation of extracellular matrix remodeling, in normal conditions or in several pulmonary diseases, such as ARDS, results from a complex mechanism that integrate the transcription of elements that destroy the matrix protein and produce activation/inhibition of several cellular types of lung tissue. This review article will analyze the ECM organization in ARDS, the different pulmonary parenchyma remodeling mechanisms, and the role of cytokines in the regulation of the different matrix components during the remodeling process.