Arterial Blood Gases after Coronary Artery Bypass Surgery

Singh, Naresh Pal; Vargas, Francisco S.; Cukier, Alberto; Filho, Mário Terra; Teixeira, Lisete R.; Light, Richard W.

doi:10.1378/chest.102.5.1337

Cited by 73 publications

(40 citation statements)

References 14 publications

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“…26,27 Consequently, a major incidence of respiratory complications during the postoperative course may occur and delay pulmonary function recovery. 28,29 This may explain our findings. The MOV group, which presented a higher incidence of cough and consequently more thoracic pain, demonstrated a greater impairment in pulmonary function at 24 h after the extubation, as demonstrated by the correlation tests applied in this study.…”

Section: Discussionsupporting

confidence: 62%

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: 62%

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

Gomes

et al. 2014

Respir Care

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“…Some authors have demonstrated there is a greater drop in the PaO 2 with the use of LITA grafts subsequent to the effect of pleurotomy with pleural drains [17]. They also commented that recovery is slower due to the presence of the drain in the thorax, that is, to the additional injury imposed of the thoracic wall [11,18].…”

Section: Discussionmentioning

confidence: 99%

“…Several mechanisms may contribute to the appearance of hypoxemia: alveolar hypoventilation, alterations in the ventilation-perfusion ratio, reduction of diffusion and shunt, with this latter being the most common [17,18]. One of the proposed mechanisms for the appearance of a shunt is the reduction of the FVC [17].…”

Section: Discussionmentioning

confidence: 99%

<![CDATA[<b>Effects of the pleural drain site on the pulmonary function after coronary artery bypass graf</b>]]>

Guizilini¹,

Gomes²,

Faresin³

et al. 2004

Braz. j. cardiovasc. surg.

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Objective: To analyze pulmonary functional changes and pain in patients undergoing off-pump coronary artery bypass grafting utilizing a left internal thoracic artery graft, comparing pleural drain insertion through the intercostal space and the subxyphoid approach.Methods: Twenty-eight patients (mean age 57.4 ± ± ± ± ± 8.4 years) were divided into two groups, according to the pleural drain site. Group LI (n=15) had the pleural drain inserted through the sixth left intercostal space at the mid-axillary line and in the MI group (n=13) the drain was placed through the subxyphoid region. All the patients underwent pre-and postoperative evaluations of pulmonary function tests as well as arterial blood gas analysis. Forced vital capacity (FVC) and forced expiratory volume over one second (FEV 1 ) were recorded in the preoperative period, and on the first, third and fifth postoperative days. The pain sensation was evaluated using a standard score from 0 to 10. Results:In both groups, falls in the FVC and FEV 1 were noted, up to the fifth postoperative day (P<0.001). However the decrease was higher in the LI group, when compared to the MI group (p<0.05). Also arterial blood gas analysis showed a decline of the partial oxygen pressure in both groups on the first postoperative day, but more significantly in the LI group (p=0.021). The pain sensation was higher in the LI group (p=0.002).Conclusion: Off-pump coronary artery bypass grafting using the left internal thoracic artery, disregarding the pleural drain site, leads to a significant decrease of postoperative pulmonary function. However, the subxyphoid technique of drain insertion has shown a better preservation of the lung function when compared to the intercostal drain site.Descriptors: Coronary artery bypass surgery. Pleural drain. Pulmonary function. 48GUIZILINI, S ET AL -Effects of the pleural drain site on the pulmonary function after coronary artery bypass grafting Bras Cir Cardiovasc 2004; 19(1): 47-54 Rev

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“…Bir çalışmada KABG sonrası ikinci günde arter kanında oksijen parsiyel basıncı değerinin en düşük düzeye ulaştığı, sonrasında tedricen arttığı, 8. gün sonunda ameliyat öncesi değerlere ulaşamadığı gösterilmiştir. [14] Çalışmamızda ameliyat sonrası 3. ayda ve 3. yılda bakılan AKG incelemelerinde ameliyat öncesi değerlere göre fark izlenmedi. Bunun nedeni AKG analizinin ameliyattan hemen sonra değil, en erken 3. ayda değerlendirilmesi olabilir, nitekim literatürde de benzer sonuçlar bildirilmiştir.…”

Section: Discussionunclassified

The effects of heart surgery on early and late pulmonary functions: the results of three-year follow-up

Inonu¹

2011

Turkish J Thorac Cardiovasc Surg

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Amaç: Bu çalışmada, kalp cerrahisinden üç ay ve üç yıl sonra pulmoner fonksiyonların değerlendirilmesi amaçlandı. Ça lış ma pla nı: Hastanemiz Kalp Damar Cerrahisi Kliniği'nde Ağustos 2005 -Mart 2006 tarihleri arasın-da elektif açık kalp cerrahisi uygulanan 25 hasta (19 erkek, 6 kadın; ort. yaş 55.5±13.4 yıl; dağılım 17-77 yıl) ileriye dönük olarak değerlendirildi. Solunum fonksiyon testleri (SFT) ve arter kan gazı (AKG) analizleri, ameliyat öncesinde ve ameliyat sonrası 3. ay ve 3. yılda yapıldı. Bul gu lar: Yirmi beş hastanın %64'üne koroner arter bypass greftleme (KABG) ameliyatı, %20'sine kapak replasmanı ameliyatı (KRA), %16'sına ise hem KABG hem de KRA uygulandı. New York Heart Association (NYHA) kalp yetmezliği sınıflamasına göre ameliyat öncesi kalp yetmezliği düzeyi hastaların %68'inde sınıf III, %24'ünde sınıf II ve %8'inde sınıf IV idi. Solunum fonksiyon testi parametrelerinden VC, FEV1, FVC, FEF25, FEF50, FEF75 ve MMEF'nin ameliyat öncesi değerleri ve ameliyat sonrası 3. ay ve 3. yıl değerleri karşılaştırıldığında fark anlamlı iken (p= 0.0001), FEV1/FVC oranı ve PEF açısından fark anlamlı değildi (p>0.05). Ameliyat öncesi ve ameliyat sonrası AKG değerleri arasında fark yoktu (p>0.05). So nuç:Bu çalışmanın en önemli sonucu, SFT parametrelerinin üç yıl sonra, ameliyat öncesi değerlere göre anlamlı derecede düşük tespit edilmesidir. Bu sonuç ameliyat sonrası oluşan fonksiyonel değişikliklerin 3. yılın sonunda bile devam ettiğini göstermesi açısından dikkate değerdir.Anah tar söz cük ler: Kardiak cerrahi; kardiopulmoner bypass; solunum fonksiyon testleri, kapak replasman ameliyatı. Background:In this study, we evaluated the pulmonary functions three months and three years after heart surgery. Methods: Twenty-five patients (19 males, 6 females; mean age 55.5±13.4 years; range 17 to 77 years) who underwent elective open heart surgery between August 2005 and March 2006 in the Cardiovascular Surgery Clinic of our hospital were prospectively evaluated. Pulmonary function tests (PFT) and arterial blood gas (ABG) analyses were performed before the operation and in the 3 rd month and 3 rd year after the operation.

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Arterial Blood Gases after Coronary Artery Bypass Surgery

Cited by 73 publications

References 14 publications

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

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

<![CDATA[<b>Effects of the pleural drain site on the pulmonary function after coronary artery bypass graf</b>]]>

The effects of heart surgery on early and late pulmonary functions: the results of three-year follow-up

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