12 Previous studies suggested that serum PCT concentrations

12 Previous studies suggested that serum PCT concentrations Lenalidomide clinical trial increase at the end of CPB, peaking on the first day and then rapidly declining.7 13 Data have suggested that significant increases in PCT levels are observed when complications present.7 14 15 Therefore, we hypothesise that PCT could serve as

a predictor of the development of ARDS, especially moderate to severe ARDS, in patients undergoing cardiac surgery with CPB. Our aim is to determine whether patients with different serum PCT concentrations exhibit different rates of developing moderate to severe ARDS. Methods and analysis Study design overview The present study is a prospective, single centre, observational cohort study involving patients undergoing elective cardiac surgery. Study setting and population The study setting is a cardiosurgical intensive care unit (ICU; 20 beds) and cardiosurgery department (118 beds) at

Fujian Provincial Hospital (2500 beds), Fujian Provincial Clinical College of Fujian Medical University, Fuzhou, China. All patients admitted to the cardiosurgery department for a cardiac surgery involving CPB were screened for study eligibility. The following inclusion criteria were used: Patients were 18 years of age and older; Patients underwent cardiac surgery involving CPB; Patients were free from active preoperative infection or inflammatory disease (all of the following criteria were achieved at study entry: leucocyte count <12×109/L, PCT <0.5 ng/mL, body temperature <37.5°C); Patients were capable of providing consent. The following exclusion criteria were used: History of chronic obstructive pulmonary disease (COPD), asthma or interstitial lung disease; History of lung surgery; Pregnant or lactating women; Unwilling to provide consent; Enrolled in another trial. Anaesthesia, CPB and perioperative management All patients undergo cardiosurgery with general anaesthesia via median sternotomy.

Anticoagulation is promoted in CPB patients via the administration of 3 mg/kg sodium heparin. After attaining an activating clotting time (ACT) greater AV-951 than 480 s, CPB is initiated by using an occlusive roller pump (Jostra, Germany) and a membrane oxygenator (Affinity7000, American) followed by moderate hypothermia (28°C) and crystalloid cardioplegic cardiac arrest. The pump flow is approximately 2.0–2.6 L/min/m2 during CPB. The mean arterial pressure is maintained at 60–80 mm Hg. At the end of surgery, protamine is administered at a 1:1 ratio to reverse the heparin effect (to obtain an ACT <160 s). The ventilator is initially set to deliver a tidal volume approximately 7–10 mL/kg, and the respiratory rate is adjusted to maintain an arterial CO2 pressure (PaCO2) of 35–40 mm Hg during the surgery. Cephazolin is administered as perioperative antibiotic prophylaxis.

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