ObjectiveTo evaluate the lung function and clinical outcome in severe chronic obstructive
pulmonary disease in patients undergoing off-pump coronary artery bypass grafting
with left internal thoracic artery graft, comparing the pleural drain insertion in
the intercostal versus subxyphoid region.MethodsA randomized controlled trial. Chronic obstructive pulmonary disease patients were
randomized into two groups according pleural drain site: II group (n=27) - pleural
drain in intercostal space; SI group (n=29) - pleural drain in the subxyphoid
region. Spirometry values (Forced Vital Capacity - and Forced expiratory volume in
1 second) were obtained on preoperative and 1, 3 and 5 postoperative days. Chest
x-ray from preoperative until postoperative day 5 (POD5) was performed for
monitoring respiratory events, such as atelectasis and pleural effusion. Pulmonary
shunt fraction and pain score was evaluate preoperatively and on postoperative day
1.ResultsIn both groups there was a significant decrease of the spirometry values (Forced
Vital Capacity and Forced expiratory volume in 1 second) until POD5 (P<0.05).
However, when compared, SI group presented less decrease in these parameters
(P<0.05). Pulmonary shunt fraction was significantly lower in SI group
(P<0.05). Respiratory events, pain score, orotracheal intubation time and
postoperative length of hospital stay were lower in the SI group (P<0.05).ConclusionSubxyphoid pleural drainage in severe Chronic obstructive pulmonary disease
patients determined better preservation and recovery of pulmonary capacity and
volumes with lower pulmonary shunt fraction and better clinical outcomes on early
postoperative off-pump coronary artery bypass grafting.
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