Infectional protection and antimicrobial support for cardiopulmonary bypass

Cardiopulmonary bypass (CPB) has been established as the gold-standard technique for performing certain heart, aorta, or lung surgeries. First, the purpose of using extracorporeal circulation is to maintain blood circulation and to provide tissue perfusion throughout the body intraoperatively. Cardiac and/or pulmonary functions should be shut down during lifesaving surgical interventions to obtain a bloodless surgical area and movement less target organs. Second, body temperature must be sustained normally, hypo- or deep hypothermic during surgical procedures, mainly to protect the cerebrum and collectively the whole body from any temporary, permanent, or fatal ischemic and reperfusion damage. Finally, adequate and aggressive immunoregulation must be maintained to prevent severe cytokine storm due to the foreign structure of the CPB circuit and infectious invasion through all invasive cannulations and intravenous treatments, as well as surgical wounds. Understanding the immunological changes associated with CPB and recognizing the factors that increase the risk of postoperative infection can help physicians develop strategies to prevent infections and sepsis. Although the benefits versus risks have not been established, it is also common practice to extend “prophylaxis” for 48 hours after open-heart surgery. Antimicrobial prophylaxis is particularly beneficial in cardiac surgery to prevent serious superficial or potentially life-threatening deep wound infections, such as mediastinitis, and it must also account for altered pharmacokinetics with CPB. This chapter focuses on infection propensity, strategies to reduce perioperative risks and preventive approaches, while elimination of microbial colonization should be the main strategy to avoid postoperative nosocomial infections.