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Original Research |

Effect of Combined Remote Ischemic Preconditioning and Postconditioning on Pulmonary Function in Valvular Heart SurgeryRemote Ischemic Conditioning and Lung Protection

Jong-Chan Kim, MD; Jae-Kwang Shim, MD, PhD; Sak Lee, MD, PhD; Young-Chul Yoo, MD; So-Young Yang, MD; Young-Lan Kwak, MD, PhD
Author and Funding Information

From the Department of Anesthesiology and Pain Medicine (Dr Kim), Kyungpook National University Hospital, Daegu; and Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute (Drs Shim, Yoo, Yang, and Kwak); Division of Cardiovascular Surgery (Dr Lee); and Severance Biomedical Science Institute (Dr Kwak), Yonsei University College of Medicine, Seoul, South Korea.

Correspondence to: Young-Lan Kwak, MD, PhD, Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Severance Biomedical Science Institute, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, South Korea; e-mail: ylkwak@yuhs.ac


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Funding/Support: The authors have reported to CHEST that no funding was received for this study.


Chest. 2012;142(2):467-475. doi:10.1378/chest.11-2246
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Background:  The aim of this study was to evaluate the lung-protective effect of combined remote ischemic preconditioning (RIPCpre) and postconditioning (RIPCpost) in patients undergoing complex valvular heart surgery.

Methods:  In this randomized, placebo-controlled, double-blind trial, 54 patients were assigned to an RIPCpre plus RIPCpost group or a control group (1:1). Patients in the RIPCpre plus RIPCpost group received three 10-min cycles of right-side lower-limb ischemia of 250 mm Hg at both 10 min after anesthetic induction and weaning from cardiopulmonary bypass. The primary end point was to compare postoperative Pao2/Fio2. Secondary end points were to compare pulmonary variables, incidence of acute lung injury, and inflammatory cytokines.

Results:  In both groups, Pao2/Fio2 at 24 h postoperation was significantly decreased compared with each corresponding baseline value. However, intergroup comparisons of pulmonary variables, including Pao2/Fio2 and incidence of acute lung injury, revealed no significant differences. Serum levels of IL-6, IL-8, IL-10, and tumor necrosis factor-α were all significantly increased in both groups compared with each corresponding baseline value, without any significant intergroup differences. There were also no significant differences in transpulmonary gradient of IL-6, IL-10, and tumor necrosis factor-α between the groups.

Conclusions:  RIPCpre plus RIPCpost as tested in this randomized controlled trial did not provide significant pulmonary benefit following complex valvular cardiac surgery.

Trial registry:  ClinicalTrials.gov; No.: NCT01427621; URL: www.clinicaltrials.gov

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