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

Abstract

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.

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

“…In previous studies in which spirometers were used as the means of assessing respiratory pressures, it was concluded that insertion of the pleural drain in the subxiphoid position was associated with lower impairment of respiratory muscle strength. 8,15,20 However, in the present study, the pleural drain position was not found to have any significant influence on maximum respiratory pressures.…”

Gait Speed and Hospital Reinternation After Coronary Artery Bypass Grafting

“…It is considered a multidimensional syndrome resulting from the reduction of physiological reserves and an increase in physical and functional decline when exposed to external stressors 16 . After cardiac surgery, factors such as cardiopulmonary bypass, surgical incision, pleurotomy and duration of mechanical ventilation generate pulmonary dysfunction and decrease in physiological reserves 17 .…”

Efeito do posicionamento do dreno pleural na função pulmonar, capacidade pulmonar e força muscular respiratória no pós-operatório de revascularização do miocárdio: revisão sistemática

“…Em todos os estudos que avaliaram a função pulmonar foi utilizada a espirometria, com as medidas de capacidade vital forçada (CVF) e volume expiratório forçado no primeiro segundo (VEF1) (Guizilini, Alves, et al, 2014;Guizilini, Viceconte, et al, 2014;Hagl et al, 1999;Vieira et al, 2012). Dois estudos avaliaram força muscular respiratória pelas medidas de pressão inspiratória máxima (Pimáx) e pressão expiratória máxima (Pemáx), obtidas por manovacuometria (Cancio et al, 2012;Simon et al, 2019).…”