912. Viral Infection as Risk Factor for Acute Lung Injury after Elective Cardiac Surgery
Session: Poster Abstract Session: Respiratory Infections
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Poster 3 IDSA Viral Infection as Risk Factor for Acute Lung.pdf (220.9 kB)
  • Background:

    Acute Lung Injury (ALI) can be caused by a ‘massive hit’ such as sepsis or major surgery, but more often is associated with multiple, sequential minor insults, one of which is thought to be clinically non-manifest infection of the lower respiratory tract (LRT) by Herpes simplex. We hypothesize that in patients undergoing cardiac surgery, non-manifest viral infection of the LRT may contribute to pulmonary injury.

    Methods:

    In a prospective cohort study, adults undergoing elective cardiac surgery were assayed for LRT viral infection by sequential perioperative mini broncho-alveolar lavage (mBAL). A multiplex real-time PCR was used for influenza A and B, respiratory syncytial virus, parainfluenza viruses 1-4, rhinovirus, metapneumovirus and coronaviruses (type 229E, NL63, OC43 and HKU1). Findings were related to post-operative ICU course and signs of pulmonary injury.

    Results:

    Forty patients (25 males; range 44 to 83 years) were enrolled. Nineteen patients underwent coronary-artery bypass grafting, 24 heart valve surgery, 13 aortic surgery and 1 patient left ventricular aneurysmectomy.

    In mBALs taken during but not after surgery, 2 patients had positive PCR findings. Six patients had first positive PCR findings after surgery.  Viruses identified: influenza A (2 positive samples in 1 patient), parainfluenza virus 1 (n=1), parainfluenza virus 2 (n=2), parainfluenza virus 3 (n=1), coronavirus OC43 (n=1) and coronavirus HKU1 (n=2).
    Patients with viral infection did not differ significantly from those without in time on mechanical ventilator and length of ICU stay. One patient without viral infection developed ALI postoperatively.

    An important criterion of ALI, the ratio of partial oxygen pressure in arterial blood and fraction of inspired oxygen (P/F ratio) after surgery, did not differ significantly in patients with viral infection (mean 303, 95%CI: 172-435) compared to patients without infection (mean 334, 95%CI: 264-404), and no differences in arterial and venous proadrenomedullin, and interleukin-8 in mBAL, were found.

    Conclusion:

    In this pilot study, non-manifest viral LRT infection was not a risk factor for pulmonary injury or adverse outcome in patient undergoing elective cardiac surgery. However, the concept of non-manifest viral infection as mediator of pulmonary injury needs further investigation.

    Geert H. Groeneveld, MD1, Judith Van Paassen2, Ann C.T.M. Vossen, MD3, M. Sesmu Arbous2 and J.T. Van Dissel, MD, PhD1, (1)Dept of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands, (2)Dept. of Intensive Care, Leiden University Medical Center, Leiden, Netherlands, (3)Dept. of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands

    Disclosures:

    G. H. Groeneveld, None

    J. Van Paassen, None

    A. C. T. M. Vossen, None

    M. S. Arbous, None

    J. T. Van Dissel, None

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