Does pleurotomy during internal mammary artery harvest increase post-operative pulmonary complications?

Wheatcroft, Mark; Shrivastava, Vivek; Nyawo, Brian; Rostron, Anthony J.; Dunning, Joel

doi:10.1510/icvts.2004.102673

Cited by 17 publications

(10 citation statements)

References 6 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: 56%

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: 56%

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

Gomes

et al. 2014

Respir Care

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“…There is clear evidence that postoperative pulmonary dysfunction of varying degrees is an inevitable consequence of cardiac surgery [2,3,13]. A number of factors appear to contribute to pulmonary function abnormalities including general anesthesia, median sternotomy, surgical injury and cardiopulmonary bypass [3,14].…”

Section: Discussionmentioning

confidence: 99%

“…However, reports have demonstrated that ITA harvesting during a CABG is an adjunctive factor for further impairment of postoperative pulmonary function, and may increase the risk of pleuropulmonary complications [2,3,13]. Previous reports attributed the postoperative poor lung function to pleurotomy followed by chest tube insertion and additional trauma to the chest wall during dissection of ITA graft [2,5,19,20].…”

Section: Discussionmentioning

confidence: 99%

Pleurotomy with subxyphoid pleural drain affords similar effects to pleural integrity in pulmonary function after off-pump coronary artery bypass graft

Guizilini

Bolzan

Faresin

et al. 2012

J Cardiothorac Surg

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BackgroundExacerbation of pulmonary dysfunction has been reported in patients receiving a pleural drain inserted through the intercostal space in comparison to patients with an intact pleura undergoing coronary artery bypass grafting (CABG). Evidence suggests that shifting the site of pleural drain insertion to the subxyphoid position minimizes chest wall trauma and preserves respiratory function in the early postoperative period. The aim of this study was to compare the pulmonary function parameters, clinical outcomes, and pain score between patients undergoing pleurotomy with pleural drain placed in the subxyphoid position and patients with intact pleural cavity after off-pump CABG (OPCAB) using left internal thoracic artery (LITA).MethodsSeventy-one patients were allocated into two groups: I (n = 38 open left pleural cavity and pleural drain inserted in the subxyphoid position); II (n = 33 intact pleural cavity). Pulmonary function tests and clinical parameters were recorded preoperatively and on postoperative days (POD) 1, 3 and 5. Arterial blood gas analysis and shunt fraction were evaluated preoperatively and in POD1. Pain score was assessed on POD1. To monitor pleural effusion and atelectasis chest radiography was performed routinely 1 day before operation and until POD5.ResultsIn both groups a significant impairment was found in lung function parameters until on POD5. However, no significant difference in forced vital capacity and forced expiratory volume in 1 second were seen between groups. A significant decrease in partial pressure of arterial oxygen and an increase in shunt fraction values were observed on POD1 in both groups, but no statistical difference was found when the groups were compared. Pleural effusion and atelectasis until on POD5 were similar in both groups. There were no statistical differences in pain score, duration of mechanical ventilation and postoperative hospital stay between groups.ConclusionSubxyphoid insertion of pleural drain provides similar effects to preserved pleural integrity in pulmonary function, clinical outcomes, and thoracic pain after OPCAB. Therefore, our results support the hypothesis that once pleural cavities are incidentally or purposely opened during LITA dissection, subxyphoid placement of the pleural drain is recommended.

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“…Indeed, higher levels of FiO 2 during mechanical ventilation because of general anesthesia during surgery are associated with atelectasis formation [27,32]. Another causative factor could be the harvesting of the internal mammary artery [33]. Use of the internal mammary artery graft has been found to be associated with a greater occurrence of post-operative atelectasis.…”

Section: Discussionmentioning

confidence: 99%

Manual hyperinflation partly prevents reductions of functional residual capacity in cardiac surgical patients - a randomized controlled trial

et al. 2011

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IntroductionCardiac surgery is associated with post-operative reductions of functional residual capacity (FRC). Manual hyperinflation (MH) aims to prevent airway plugging, and as such could prevent the reduction of FRC after surgery. The main purpose of this study was to determine the effect of MH on post-operative FRC of cardiac surgical patients.MethodsThis was a randomized controlled trial of patients after elective coronary artery bypass graft and/or valve surgery admitted to the intensive care unit (ICU) of a university hospital. Patients were randomly assigned to a "routine MH group" (MH was performed within 30 minutes after admission to the ICU and every 6 hours thereafter, and before tracheal extubation), or a "control group" (MH was performed only if perceptible (audible) sputum was present in the larger airways causing problems with mechanical ventilation, or if oxygen saturation (SpO2) dropped below 92%). The primary endpoint was the reduction of FRC from the day before cardiac surgery to one, three, and five days after tracheal extubation. Secondary endpoints were SpO2 (at similar time points) and chest radiograph abnormalities, including atelectasis (at three days after tracheal extubation).ResultsA total of 100 patients were enrolled. Patients in the routine MH group showed a decrease of FRC on the first post-operative day to 71% of the pre-operative value, versus 57% in the control group (P = 0.002). Differences in FRC became less prominent over time; differences between the two study groups were no longer statistically significant at Day 5. There were no differences in SpO2 between the study groups. Chest radiographs showed more abnormalities (merely atelectasis) in the control group compared to patients in the routine MH group (P = 0.002).ConclusionsMH partly prevents the reduction of FRC in the first post-operative days after cardiac surgery.Trial registrationNetherlands Trial Register (NTR): NTR1384. http://www.trialregister.nl

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Does pleurotomy during internal mammary artery harvest increase post-operative pulmonary complications?

Cited by 17 publications

References 6 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

Pleurotomy with subxyphoid pleural drain affords similar effects to pleural integrity in pulmonary function after off-pump coronary artery bypass graft

Manual hyperinflation partly prevents reductions of functional residual capacity in cardiac surgical patients - a randomized controlled trial

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