Influence of Pleurotomy on Pulmonary Function After Off-Pump Coronary Artery Bypass Grafting

Guizilini, Solange; Gomes, Walter J.; Faresin, Sônia Maria; Bolzan, Douglas W.; Buffolo, Ênio; Carvalho, Antônio Carlos; Paola, Ângelo A. V. de

doi:10.1016/j.athoracsur.2007.04.062

Cited by 40 publications

(55 citation statements)

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“…[19][20][21][22][23][24] Similar results were found in our study. Conventionally, coronary artery bypass grafting involves trauma to the rib cage, which causes pain that can be intensified by coughing.…”

Section: Discussionsupporting

confidence: 82%

Clinical Use of the Volume-Time Curve for Endotracheal Tube Cuff Management

Gomes

et al. 2014

Respir Care

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BACKGROUND: Previous investigation showed that the volume-time curve technique could be an alternative for endotracheal tube (ETT) cuff management. However, the clinical impact of the volume-time curve application has not been documented. The purpose of this study was to compare the occurrence and intensity of a sore throat, cough, thoracic pain, and pulmonary function between these 2 techniques for ETT cuff management: volume-time curve technique versus minimal occlusive volume (MOV) technique after coronary artery bypass grafting. METHODS: A total of 450 subjects were randomized into 2 groups for cuff management after intubation: MOV group (n ‫؍‬ 222) and volume-time curve group (n ‫؍‬ 228). We measured cuff pressure before extubation. We performed spirometry 24 h before and after surgery. We graded sore throat and cough according to a 4-point scale at 1, 24, 72, and 120 h after extubation and assessed thoracic pain at 24 h after extubation and quantified the level of pain by a 10-point scale. RESULTS: The volume-time curve group presented significantly lower cuff pressure (30.9 ؎ 2.8 vs 37.7 ؎ 3.4 cm H 2 O), less incidence and intensity of sore throat (1 h, 23.7 vs 51.4%; and 24 h, 18.9 vs 40.5%, P < .001), cough (1 h, 19.3 vs 48.6%; and 24 h, 18.4 vs 42.3%, P < .001), thoracic pain (5.2 ؎ 1.8 vs 7.1 ؎ 1.7), better preservation of FVC (49.5 ؎ 9.9 vs 41.8 ؎ 12.9%, P ‫؍‬ .005), and FEV 1 (46.6 ؎ 1.8 vs 38.6 ؎ 1.4%, P ‫؍‬ .005) compared with the MOV group. CONCLUSIONS: The subjects who received the volumetime curve technique for ETT cuff management presented a significantly lower incidence and severity of sore throat and cough, less thoracic pain, and minimally impaired pulmonary function than those subjects who received the MOV technique during the first 24 h after coronary artery bypass grafting.

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Section: Discussionsupporting

confidence: 82%

Clinical Use of the Volume-Time Curve for Endotracheal Tube Cuff Management

Gomes

et al. 2014

Respir Care

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“…Patients with pleural opening had more pain associated with a greater reduction in lung volumes and capacities during the first week after surgery [20,21]. Hagl et al [4] also showed that pain in patients with subxyphoid drain position was lower compared to intercostal tube drainage.…”

Section: Data Expressed As Mean ± Standard Deviation P Values For Comentioning

confidence: 98%

Dreno pleural subxifoide confere menor comprometimento da força muscular respiratória, oxigenação e menor dor torácica após cirurgia de revascularização do miocárdio sem circulação extracorpórea

Cancio¹,

Guizilini²,

Bolzan³

et al. 2012

Rev Bras Cir Cardiovasc

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Dreno pleural subxifoide confere menor comprometimento da força muscular respiratória, oxigenação e menor dor torácica após cirurgia de revascularização do miocárdio sem circulação extracorpórea: estudo controlado randomizado Subxyphoid pleural drain confers lesser impairment in respiratory muscle strength, oxygenation and lower chest pain after off-pump coronary artery bypass grafting: a randomized controlled trial Abstract Objective: To evaluate respiratory muscle strength, oxygenation and chest pain in patients undergoing off-pump coronary artery bypass (OPCAB) using internal thoracic artery grafts comparing pleural drain insertion site at the subxyphoid region versus the lateral region.Methods: Forty patients were randomized into two groups in accordance with the pleural drain site. Group II (n = 19) -pleural drain exteriorized in the intercostal space; group (SI) (n = 21) chest tube exteriorized at the subxyphoid region. All patients underwent assessment of respiratory muscle strength (inspiratory and expiratory) on the pre, 1, 3 and 5 postoperative days (POD). Arterial blood gas analysis was collected on the pre and POD1. The chest pain sensation was measured 1, 3 and 5 POD.Results: A significant decrease in respiratory muscle strength (inspiratory and expiratory) was seen in both groups until POD5 (P <0.05). When compared, the difference between groups remained significant with greater decrease in the II (P <0.05). The blood arterial oxygenation fell in both groups (P <0.05), but the oxygenation was lower in the II (P <0.05). Referred chest pain was higher 1, 3 and 5 POD in the II group (P <0.05). The orotracheal intubation time and postoperative length of hospital stay were higher in the II group (P <0.05).Conclusion: Patients submitted to subxyphoid pleural drainage showed less decrease in respiratory muscle strength, better preservation of blood oxygenation and reduced thoracic pain compared to patients with intercostal drain on early OPCAB postoperative. 104Cancio ASA, et al. -Subxyphoid pleural drain confers lesser impairment in respiratory muscle strength, oxygenation and lower chest pain after off-pump coronary artery bypass grafting: a randomized controlled trial Bras Cir Cardiovasc 2012;27(1):103-9 Rev

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“…The etiology of the significant decrease in the pulmonary function after the CABG surgery is the result of the combination of several factors, such as general anesthesia, the use of the midsternotomy, on-pump surgeries and the presence of pain 3,11,12 . Moreover, the use of the LITA, which typically necessitates the insertion of a pleural drain, can be an adjuvant factor for PO pulmonary dysfunction [13][14][15] .…”

Section: Discussionmentioning

confidence: 99%

“…A considerable number of patients that are currently referred to CABG surgery present respiratory function impairment and, consequently, is at increased risk of developing postoperative pulmonary complications. Evidence has demonstrated that in the CABG surgery, regardless of the surgical technique employed, there is a decrease in the pulmonary function in the early postoperative period 3 .…”

Section: Introductionmentioning

confidence: 99%