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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 / 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

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 / 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

Background: Beta blockers are recommended by the American College of Cardiology/American Heart Association Guidelines for high and intermediate-risk cardiac patients undergoing non-cardiac surgery. Beta blockers are a class of drugs that moderate the effects of increased catecholamine levels on the heart by selectively blocking beta receptors in the heart and blood vessels, resulting in a lower heart rate and blood pressure. Beta blocker use perioperatively has been shown to reduce the risk of ischemia and infarction. Purpose: The purpose of this project is to address beta blocker use in a group of anesthesia providers who routinely attend to high-risk and intermediate-risk cardiac patients undergoing non-cardiac surgery in a medium-sized private hospital in suburban South Florida. There are barriers to the implementation of the published guidelines for beta blocker administration, including lack of awareness of the best current practice and a lack of a formal beta blocker protocol at the institutional level. Methods: A simple and inexpensive beta blocker protocol was implemented and evaluated by various means. Beta blocker administration practices were examined and documented prior to and after protocol implementation. Beta blocker usage was examined prior to and after protocol implementation Findings/Implications: It was hypothesized that increased anesthesia provider awareness would lead to increased administration of perioperative beta blockers to high-risk and intermediate-risk cardiac patients undergoing non-cardiac procedures. Although there was a knowledge increase related to the new beta blocker protocol, no change in practice was observed.