Sub-xyphoid pleural drain as a determinant of functional capacity and clinical results after off-pump coronary artery bypass surgery: a randomized clinical trial

Guizilini, Solange; Alves, Daniel F.; Bolzan, Douglas W.; Cancio, Andreia S. A.; Regenga, Marisa M.; Moreira, Rita Simone Lopes; Trimer, Renata; Gomes, Walter J.

doi:10.1093/icvts/ivu138

Cited by 13 publications

(20 citation statements)

References 27 publications

(32 reference statements)

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“…However, cerebral injury following resuscitation remains difficult issue for complete rehabilitation (21). Following successful CPR, the autonomic circulation recovery of the cerebral blood flow causes cerebral-reperfusion injury and may cause further aggravation of the prognosis of cerebral functions and mortality (22). In present study, quercetin significantly reduced the LVDs, increased the EF, FS, SV and CO, and enhanced left ventricle weight/body weight in CPR model rats.…”

Section: Discussionsupporting

confidence: 48%

Quercetin protects against inflammation, MMP‑2 activation and apoptosis induction in rat model of cardiopulmonary resuscitation through modulating Bmi‑1 expression

et al. 2018

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With extensive pharmacological actions, quercetin has anti‑oxidant, free radical scavenging, anti‑tumor, anti‑inflammatory, anti‑bacterial and anti‑viral activity. Quercetin also reduces blood glucose and reduces high blood pressure, and has immunoregulation and cardiovascular protection functions. Additionally, it has been reported that it can reduce depression. The current study evaluated whether quercetin protects against inflammation, matrix metalloproteinase‑2 (MMP‑2) activation and apoptosis induction in a rat model of cardiopulmonary resuscitation (CPR), and whether Bmi‑1 expression was involved in the effects. In CPR model rats, treatment with quercetin significantly recovered left ventricular ejection fraction, left ventricular fractional shortening, ejection fraction (%), and left ventricle weight/body weight. Treatment with quercetin significantly inhibited ROS generation, inflammation and MMP‑2 protein expression in the rat model CPR. Finally, quercetin significantly suppressed caspase‑3 activity and activated Bmi‑1 protein expression in the rat model of CPR. The results demonstrated that quercetin protects against inflammation, MMP‑2 activation and apoptosis induction in a rat model of CPR, and that this may be mediated by modulating Bmi‑1 expression.

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Section: Discussionsupporting

confidence: 48%

Quercetin protects against inflammation, MMP‑2 activation and apoptosis induction in rat model of cardiopulmonary resuscitation through modulating Bmi‑1 expression

et al. 2018

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“…According to previous research, due to the multifactorial impairment of pulmonary function [5,19-23] , there is a significant risk of respiratory complications during the postoperative period, which may result in prolonged time of mechanical ventilation, longer postoperative hospital stay, and possibly death [5,20,21] . Those results are in agreement with our findings; the CMV and L-OLS groups with greater pulmonary function impairment also showed a significantly greater intubation time and hospital stay in comparison to the E-OLS group.…”

Section: Discussionmentioning

confidence: 99%

Early open-lung ventilation improves clinical outcomes in patients with left cardiac dysfunction undergoing off-pump coronary artery bypass: A randomized controlled trial

Bolzan

Gomes

Rocco

et al. 2016

Brazilian Journal of Cardiovascular Surgery

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ObjectiveTo compare pulmonary function, functional capacity and clinical outcomes amongst three groups of patients with left ventricular dysfunction following off-pump coronary artery bypass, namely: 1) conventional mechanical ventilation (CMV); 2) late open lung strategy (L-OLS); and 3) early open lung strategy (E-OLS).MethodsSixty-one patients were randomized into 3 groups: 1) CMV (n=21); 2) L-OLS (n=20) initiated after intensive care unit arrival; and 3) E-OLS (n=20) initiated after intubation. Spirometry was performed at bedside on preoperative and postoperative days (PODs) 1, 3, and 5. Partial pressure of arterial oxygen (PaO2) and pulmonary shunt fraction were evaluated preoperatively and on POD1. The 6-minute walk test was applied on the day before the operation and on POD5.ResultsBoth the open lung groups demonstrated higher forced vital capacity and forced expiratory volume in 1 second on PODs 1, 3 and 5 when compared to the CMV group (P<0.05). The 6-minute walk test distance was more preserved, shunt fraction was lower, and PaO2 was higher in both open-lung groups (P<0.05). Open-lung groups had shorter intubation time and hospital stay and also fewer respiratory events (P<0.05). Key measures were significantly more favorable in the E-OLS group compared to the L-OLS group.ConclusionBoth OLSs (L-OLS and E-OLS) were able to promote higher preservation of pulmonary function, greater recovery of functional capacity and better clinical outcomes following off-pump coronary artery bypass when compared to conventional mechanical ventilation. However, in this group of patients with reduced left ventricular function, initiation of the OLS intra-operatively was found to be more beneficial and optimal when compared to OLS initiation after intensive care unit arrival.

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“…Respiratory events were also evaluated (atelectasis, pleural effusions, and pneumonia). Pleural effusion was considered relevant when exceeding the phreno-costal angle and fluid drainage was monitored hourly [ 4 ] . Atelectasis was acknowledged when a clear atelectasis radiological shadow exceeded 15 mm in width [ 4 ] ; linear atelectasis was disregarded in this study.…”

Section: Methodsmentioning

confidence: 99%

“…Elevated blood lactate level and low central venous oxygen saturation (ScvO 2 ) have been independently associated with an increased risk of complications and longer postoperative hospital stay following cardiac surgery, contributing to increased morbidity and mortality after coronary artery bypass surgery (CABG) [ 1 - 3 ] . In addition, several studies have shown that postoperative pulmonary dysfunction following CABG is inevitable, which could increase the occurrence of respiratory complications and delay recovery [ 4 - 6 ] .…”

Section: Introductionmentioning

confidence: 99%

Extended-time of Noninvasive Positive Pressure Ventilation Improves Tissue Perfusion after Coronary Artery Bypass Surgery: a Randomized Clinical Trial

Nasrala¹,

Bolzan²,

Lage³

et al. 2018

Braz J Cardiovasc Surg

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ObjectiveTo compare the effects of extended- versus short-time noninvasive positive pressure ventilation on pulmonary function, tissue perfusion, and clinical outcomes in the early postoperative period following coronary artery bypass surgery in patients with preserved left ventricular function.MethodsPatients were randomized into two groups according to noninvasive positive pressure ventilation intensity: short-time noninvasive positive pressure ventilation n=20 (S-NPPV) and extended-time noninvasive positive pressure ventilation n=21 (E-NPPV). S-NPPV was applied for 60 minutes during immediate postoperative period and 10 minutes, twice daily, from postoperative days 1-5. E-NPPV was performed for at least six hours during immediate postoperative period and 60 minutes, twice daily, from postoperative days 1-5. As a primary outcome, tissue perfusion was determined by central venous oxygen saturation and blood lactate level measured after anesthetic induction, immediately after extubation and following noninvasive positive pressure ventilation protocols. As a secondary outcome, pulmonary function tests were performed preoperatively and in the postoperative days 1, 3, and 5; clinical outcomes were recorded. ResultsSignificant drop in blood lactate levels and an improvement in central venous oxygen saturation values in the E-NPPV group were observed when compared with S-NPPV group after study protocol (P<0.01). The E-NPPV group presented higher preservation of postoperative pulmonary function as well as lower incidence of respiratory events and shorter postoperative hospital stay (P<0.05).ConclusionProphylactic E-NPPV administered in the early postoperative period of coronary artery bypass surgery resulted in greater improvements in tissue perfusion, pulmonary function and clinical outcomes than S-NPPV, in patients with preserved left ventricular function.Trial RegistrationBrazilian Registry of Clinical trial - RBR7sqj78 - http://www.ensaiosclinicos.gov.br

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Sub-xyphoid pleural drain as a determinant of functional capacity and clinical results after off-pump coronary artery bypass surgery: a randomized clinical trial

Abstract: Sub-xyphoid pleural drain determined better functional capacity and exercise tolerance with a smaller pulmonary shunt fraction and improved clinical outcomes compared with intercostal pleural drainage after off-pump coronary artery bypass surgery.

Cited by 13 publications

References 27 publications

Quercetin protects against inflammation, MMP‑2 activation and apoptosis induction in rat model of cardiopulmonary resuscitation through modulating Bmi‑1 expression

Quercetin protects against inflammation, MMP‑2 activation and apoptosis induction in rat model of cardiopulmonary resuscitation through modulating Bmi‑1 expression

Early open-lung ventilation improves clinical outcomes in patients with left cardiac dysfunction undergoing off-pump coronary artery bypass: A randomized controlled trial

Extended-time of Noninvasive Positive Pressure Ventilation Improves Tissue Perfusion after Coronary Artery Bypass Surgery: a Randomized Clinical Trial

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