The inflammatory response to cardiopulmonary bypass - Should it be treated?

Proinflammatory cytokines, including tumor necrosis factor (TNF) α and the interleukins, are important in the metabolic response to injury or infection. Although the importance of cytokine release during cardiopulmonary bypass (CPB) is not fully appreciated, increasing numbers of publications present evidence that cytokine release during CPB is detrimental. In addition, endogenous inhibitors of cytokine function, including TNF-soluble receptor and interleukin 1 receptor antagonist, are released in response to elevated proinflammatory cytokine levels during and after CPB. The involvement of these endogenous inhibitors in the pathophysiology of proinflammatory cytokine-induced solid organ injury after CPB remains to be defined.