Pulmonary function 4 months after coronary artery bypass graft surgery

Abstract

The objective of this study was to describe the pulmonary function and pain 4 months after coronary artery bypass graft surgery. Twenty-five male patients performed pulmonary function tests before surgery, on the 4th postoperative day and 4 months after surgery. A severe reduction in pulmonary function was present after surgery. Four months postoperatively, the patients still showed a significant decrease (6-13% of preoperative values) in vital capacity (P<0.001), inspiratory capacity (P<0.001), forced expiratory volume in 1 s (P<0.001) peak expiratory flow rate (P<0.001), functional residual capacity (P=0.05) total lung capacity (P<0.001) and single-breath carbon monoxide diffusing capacity (P<0.01). Residual volume and single-breath carbon monoxide diffusing capacity per litre of alveolar volume had returned to the preoperative level. Four months postoperatively, the median values for sternotomy pain while taking a deep breath was 0.2 and while coughing 0.3 on a 10 cm visual analogue pain scale. In conclusion, a significant restrictive pulmonary impairment persisting up to 4 months into the postoperative period was found after CABG. Measured levels of pain were low and could not explain the impairment.

The Influences of Positive End Expiratory Pressure (Peep) Associated With Physiotherapy Intervention in Phase I Cardiac Rehabilitation

“…Alterations in pulmonary function after cardiac surgery were observed in this study, in agreement with other findings, which supports that a reduction in functional residual capacity (FRC) 27 , VC, 13,14,23,28,29 and expiratory flows 11,13,14 occurs following cardiac surgery. According to published studies, the FVC presents a general reduction for a minimum period of 10 to 14 days.…”

“…7,8 In spite of modernization of procedures, cardiac surgery can damage pulmonary function, with decreases of respiratory muscle strength and spirometric measurements occurring postoperatively, in addition to the occurrence of atelectasis in more than 90% of the patients. 9 Reduction in oxygenation, 10 pulmonary function, 11,12,13,14 and respiratory muscle strength, 4,5,9,12 as well as radiological changes such as atelectasis 8,12,15 have been cited as common alterations in postoperative cardiac surgery. The reduction of respiratory muscle strength, resulting from direct or indirect lesion of respiratory muscles during surgery and the secondary diaphragmatic dysfunction due to phrenic nerve lesion, has also been related to reduced pulmonary function tests, worsened gas exchange, and increase in the rate of pulmonary complications.…”

“…11,13,18,19 The application of deep breathing exercises, cough stimulation, thumping and vibration of the rib cage, and continuous positive airway pressure may prevent further deterioration in pulmonary function and reduce the incidence of pulmonary complications. 18 However, Jenkins et al 19 observed that deep breathing exercises, thumping and vibration of the rib cages, and cough stimulation did not result in significant increases in spirometric measurements when compared to the control group.…”

Fisioterapia respiratória na disfunção pulmonar pós-cirurgia cardíaca

“…The most common radiological changes observed in the PO is atelectasis [22,26,28,36,37]. These findings were radiologically confirmed [21] by TCT [28], mainly in relation to the left lower lobe.…”

“…The reduction in lung volume and capacity contributes to changes in gas exchange, resulting in hypoxemia [15,17,28,33,35] and decreasing diffusion capacity [21]. Restrictive presentation often persists over more than 116 days [32,36].…”