Dreno pleural subxifoide confere menor comprometimento da força muscular respiratória, oxigenação e menor dor torácica após cirurgia de revascularização do miocárdio sem circulação extracorpórea

Cancio, Andreia S. A.; Guizilini, Solange; Bolzan, Douglas W.; Dauar, Renato Bauab; Succi, José Ernesto; Paola, Ângelo A. V. de; Carvalho, Antônio Carlos; Gomes, Walter J.

doi:10.5935/1678-9741.20120015

Cited by 12 publications

(11 citation statements)

References 14 publications

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“…xiphoid position with lower intensities of pain and dyspnea, [14][15][16]18 we did not observe any differences between the groups regarding the subjectively assessed degrees of dyspnea and pain. The shorter time for which the pleural drain was used in the lateral group may have influenced these results.…”

Section: Discussioncontrasting

confidence: 48%

“…The sample size calculation was performed using the WinPepi software for Windows. Based on data from a previous randomized trial that assessed maximal respiratory pressures among patients undergoing CABG surgery, 16 we found that we would need a sample size of 20 participants in each group to find a difference in predicted percentage for MIP of 14% between the groups, considering standard deviations of 15% both in group 1 and in group 2, a study power of 80%, and an alpha level of 0.05.…”

Section: Sample Calculationmentioning

confidence: 99%

“…were conducted among patients undergoing CABG surgery without extracorporeal circulation (ECC), [15][16][17]20,21 without prior pulmonary disease, [14][15][16]18,19 and with use of spirometry rather than manovacuometry to evaluate respiratory muscle strength. 14,15,[18][19][20]…”

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confidence: 99%

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Left lateral intercostal region versus subxiphoid position for pleural drain during elective coronary artery bypass graft surgery: randomized clinical trial

et al. 2019

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INTRODUCTION Coronary artery bypass graft (CABG) surgery is associated with higher survival rates and better quality of life among patients with coronary artery disease. 1,2 Use of left internal thoracic artery (LITA) grafts has been correlated with long-term benefits, 3 but this often requires pleurotomy and insertion of tubes to drain the cavity. 4,5 Pleural drains can be inserted into the subxiphoid region or the intercostal space with the main objective of maintaining or restoring the negative pressure of the pleural space. 6 However, they may impair the integrity of the ventilatory system, thereby compromising the respiratory mechanics and gas exchange after surgery. 7-9 Respiratory muscle strength may be evaluated through maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP), which indicate the strength of the inspiratory and expiratory muscle groups respectively. 10 Predictions for MIP and MEP according to age and sex should preferably be considered within their clinical setting, because they may lead to a prognosis of postoperative pulmonary complications like respiratory muscle fatigue or failure. 11-13 MIP and MEP can be measured with the aid of a manometer or manovacuometer. In addition to being practical and non-invasive, this equipment has low cost, is easy to apply at the bedside and only requires simple inspiration and expiration movements from the patient. Studies on individuals undergoing CABG surgery have shown that insertion of the pleural drain in the subxiphoid position can minimize the chance of trauma to the thoracic wall, may preserve respiratory function in the immediate postoperative period and may lead to lower levels of subjective pain, compared with lateral intercostal insertion. 14-20 However, most of these studies

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Section: Discussioncontrasting

confidence: 48%

Section: Sample Calculationmentioning

confidence: 99%

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Left lateral intercostal region versus subxiphoid position for pleural drain during elective coronary artery bypass graft surgery: randomized clinical trial

et al. 2019

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“…Pleural drain insertion through intercostal space promotes higher thoracic trauma, increased pain and discomfort for the patient, leading to increased vulnerability to lung complications. In patients without COPD undergoing off-pump CABG (OPCAB), the shift of pleural drain insertion to subxyphoid region reduces postoperative pulmonary dysfunction [ 6 , 7 ] . Our hypothesis is that reducing thoracic trauma in COPD patients underwent OPCAB could determine lower impairment to the lung function and better clinical results.…”

Section: Introductionmentioning

confidence: 99%

Pleural subxyphoid drain confers better pulmonary function and clinical outcomes in chronic obstructive pulmonary disease after off-pump coronary artery bypass grafting: a randomized controlled trial

Guizilini¹,

Viceconte²,

Esperança³

et al. 2014

Revista Brasileira De Cirurgia Cardiovascular

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ObjectiveTo evaluate the lung function and clinical outcome in severe chronic obstructive pulmonary disease in patients undergoing off-pump coronary artery bypass grafting with left internal thoracic artery graft, comparing the pleural drain insertion in the intercostal versus subxyphoid region.MethodsA randomized controlled trial. Chronic obstructive pulmonary disease patients were randomized into two groups according pleural drain site: II group (n=27) - pleural drain in intercostal space; SI group (n=29) - pleural drain in the subxyphoid region. Spirometry values (Forced Vital Capacity - and Forced expiratory volume in 1 second) were obtained on preoperative and 1, 3 and 5 postoperative days. Chest x-ray from preoperative until postoperative day 5 (POD5) was performed for monitoring respiratory events, such as atelectasis and pleural effusion. Pulmonary shunt fraction and pain score was evaluate preoperatively and on postoperative day 1.ResultsIn both groups there was a significant decrease of the spirometry values (Forced Vital Capacity and Forced expiratory volume in 1 second) until POD5 (P<0.05). However, when compared, SI group presented less decrease in these parameters (P<0.05). Pulmonary shunt fraction was significantly lower in SI group (P<0.05). Respiratory events, pain score, orotracheal intubation time and postoperative length of hospital stay were lower in the SI group (P<0.05).ConclusionSubxyphoid pleural drainage in severe Chronic obstructive pulmonary disease patients determined better preservation and recovery of pulmonary capacity and volumes with lower pulmonary shunt fraction and better clinical outcomes on early postoperative off-pump coronary artery bypass grafting.

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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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Dreno pleural subxifoide confere menor comprometimento da força muscular respiratória, oxigenação e menor dor torácica após cirurgia de revascularização do miocárdio sem circulação extracorpórea

Cited by 12 publications

References 14 publications

Left lateral intercostal region versus subxiphoid position for pleural drain during elective coronary artery bypass graft surgery: randomized clinical trial

Left lateral intercostal region versus subxiphoid position for pleural drain during elective coronary artery bypass graft surgery: randomized clinical trial

Pleural subxyphoid drain confers better pulmonary function and clinical outcomes in chronic obstructive pulmonary disease after off-pump coronary artery bypass grafting: a randomized controlled trial

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

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