Preoperative expiratory and inspiratory muscle weakness to predict postoperative outcomes in patients undergoing elective cardiac surgery

Abstract

Background: Few studies have evaluated preoperative respiratory muscle strength as a risk factor for postoperative morbidity and mortality. The objective of this study was to evaluate the association of preoperative inspiratory muscle weakness (IMW) and preoperative expiratory muscle weakness (EMW) with duration of mechanical ventilation, length of stay in the intensive care unit (ICU), incidence of postoperative pulmonary complications (PPCs), and mortality in patients undergoing elective cardiac surgery. Materials and methods:This was a prospective observational study. Patients admitted for elective cardiac surgery were recruited. Maximal inspiratory and expiratory pressure were measured before surgery. A multivariate regression model was used to adjust for possible confounding variables and test the association of IMW and EMW with the duration of mechanical ventilation, length of stay in the ICU, PPCs, and hospital mortality.Results: Two hundred and fifty-five patients were included in this study. The presence of IMW was associated with an increase in the duration of mechanical ventilation (P = .012). The presence of EMW was associated with a reduction in the incidence of PPCs (P = .005). IMW had no significant association with length of stay in the ICU, PPCs, or hospital mortality. EMW had no significant association with the duration of mechanical ventilation, length of stay in the ICU, or hospital mortality. Conclusions:In patients undergoing elective cardiac surgery, preoperative IMW is associated with the duration of mechanical ventilation while preoperative EMW is associated with a decrease in PPCs.

Diaphragm Ultrasound in Cardiac Surgery: State of the Art

“…In addition, obesity and arterial hypertension may be risk factors for post-operative diaphragmatic dysfunction [4]. Preoperative inspiratory muscle weakness may predict the postoperative duration of mechanical ventilation in patients undergoing cardiac surgery [5]. Clinically, patients with bilateral diaphragm paralysis disclose orthopnea, rapid shallow breathing, and thoraco-abdominal paradoxus in the supine position [48].…”

“…In cardiac surgery, patients are at risk of phrenic nerve injury, which leads to diaphragm dysfunction (DD) [1]. The onset of DD is a serious outcome, affecting morbidity and length of hospital stay [1][2][3][4][5]. This is particularly a pejorative burden in patients with previous pulmonary diseases.…”

Outcomes of Renal Function in Cardiogenic Shock Patients With or Without Mechanical Circulatory Support

“…Percutaneous MCS has emerged as an effective strategy in protecting end organ function during high risk percutaneous coronary intervention (PCI) [ 4 ]. Modalities of percutaneous MCS exist based on their different distinct hemodynamic profile, but all available devices to a variable degree, improve cardiac output and blood pressure [ 1 , 2 , 4 - 6 ].…”

“…Percutaneous MCS has emerged as an effective strategy in protecting end organ function during high risk percutaneous coronary intervention (PCI) [ 4 ]. Modalities of percutaneous MCS exist based on their different distinct hemodynamic profile, but all available devices to a variable degree, improve cardiac output and blood pressure [ 1 , 2 , 4 - 6 ]. Intra-aortic balloon pump (IABP) counter pulsation therapy is used in patients with cardiogenic shock with the goal of decreasing myocardial oxygen consumption, increasing coronary artery perfusion, decreasing afterload and enhancing cardiac output [ 1 , 5 ].…”

“…Impella supported PCI has shown to decrease ischemic kidney injury from episodic hypoperfusion, whereas conflicting reports exist regarding the existence of improvement of renal function with the use of IABP [ 4 - 6 ]. In the setting of cardiogenic shock in patients who underwent PCI/coronary artery bypass graft (CABG) with complex coronary revascularization, there are little comparative data amongst different MCS modalities displaying superiority in improvement of renal status.…”