Postoperative cardiac surgical care: an alternative approach

Jindani, A; Williams, B.

doi:10.1136/hrt.70.1.98

Cited by 3 publications

(3 citation statements)

References 5 publications

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“…Furthermore, our results are comparable with the reported incidence of atelectasis of 90% found with thoracic CT scan in anaesthetised patients . The incidence of clinically‐relevant PPCs in our study was comparable with rates described before, making our results generalisable to the postoperative population . Of note, more clinically‐relevant PPCs were detected by lung ultrasound, although this clinically‐relevant composite reference standard was based on CXR findings, among others.…”

Section: Discussionsupporting

confidence: 91%

Lung ultrasound compared with chest X‐ray in diagnosing postoperative pulmonary complications following cardiothoracic surgery: a prospective observational study

Touw

Parlevliet²,

Beerepoot³

et al. 2018

Anaesthesia

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SummaryPostoperative pulmonary complications are common after cardiothoracic surgery and are associated with adverse outcomes. The ability to detect postoperative pulmonary complications using chest X‐rays is limited, and this technique requires radiation exposure. Little is known about the diagnostic accuracy of lung ultrasound for the detection of postoperative pulmonary complications after cardiothoracic surgery, and we therefore aimed to compare lung ultrasound with chest X‐ray to detect postoperative pulmonary complications in this group of patients. We performed this prospective, observational, single‐centre study in a tertiary intensive care unit treating adult patients who had undergone cardiothoracic surgery. We recorded chest X‐ray findings upon admission and on postoperative days 2 and 3, as well as rates of postoperative pulmonary complications and clinically‐relevant postoperative pulmonary complications that required therapy according to the treating physician as part of their standard clinical practice. Lung ultrasound was performed by an independent researcher at the time of chest X‐ray. We compared lung ultrasound with chest X‐ray for the detection of postoperative pulmonary complications and clinically‐relevant postoperative pulmonary complications. We also assessed inter‐observer agreement for lung ultrasound, and the time to perform both imaging techniques. Subgroup analyses were performed to compare the time to detection of clinically‐relevant postoperative pulmonary complications by both modalities. We recruited a total of 177 patients in whom both lung ultrasound and chest X‐ray imaging were performed. Lung ultrasound identified 159 (90%) postoperative pulmonary complications on the day of admission compared with 107 (61%) identified with chest X‐ray (p < 0.001). Lung ultrasound identified 11 out of 17 patients (65%) and chest X‐ray 7 out of 17 patients (41%) with clinically‐relevant postoperative pulmonary complications (p < 0.001). The clinically‐relevant postoperative pulmonary complications were detected earlier using lung ultrasound compared with chest X‐ray (p = 0.024). Overall inter‐observer agreement for lung ultrasound was excellent (κ = 0.907, p < 0.001). Following cardiothoracic surgery, lung ultrasound detected more postoperative pulmonary complications and clinically‐relevant postoperative pulmonary complications than chest X‐ray, and at an earlier time‐point. Our results suggest lung ultrasound may be used as the primary imaging technique to search for postoperative pulmonary complications after cardiothoracic surgery, and will enhance bedside decision making.

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Section: Discussionsupporting

confidence: 91%

Lung ultrasound compared with chest X‐ray in diagnosing postoperative pulmonary complications following cardiothoracic surgery: a prospective observational study

Touw

Parlevliet²,

Beerepoot³

et al. 2018

Anaesthesia

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“…The incidence of pneumonia after CABG is 3% to 16%. 16 Atelectasis, being implicated as the most important and frequent problem after thoracic surgery, occurs in 73% of patients after internal mammary artery grafting 17 that reduces lung compliance and functional residual capacity. The development of interstitial oedema contributes significantly to the mechanical and gas exchange abnormalities.…”

Section: Discussionmentioning

confidence: 99%

Effect of Coronary Artery Bypass Grafting Surgery on Pulmonary Function Tests and Arterial Blood Gases

Jasani¹,

Awad²,

Raut³

2022

The Indian Journal of Chest Diseases and Allied Sciences

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Background and Objective.Pulmonary dysfunction after open heart surgery is an important cause of post-operative morbidity. To evaluate effect of coronary artery bypass grafting (CABG) surgery on pulmonary functions and arterial blood gases (ABGs).Methods. A prospective study was conducted at a pulmonary unit of a tertiary care public hospital. Of the 50 patients enrolled, 42 patients completed the study. Spirometry was performed one week pre-operatively and within four to five weeks post-operatively. Arterial blood gas samples were also collected just before spirometry. The pre-and post-operative data were compared.Results. There was significant reduction in forced vital capacity (FVC) and forced expiratory volume in one second (FEV 1 ) by 13.8% and 13.1%, respectively within five weeks of surgery. After surgery mean maximum voluntary ventilation (MVV) showed a significant decrease of 7.6%. Post-operatively, the mean pH decreased significantly by 0.1% and the mean partial pressure of oxygen (PaO 2 ) and oxygen saturation SpO 2 showed significant decrease of 10.1% and 2.4%, respectively. Conclusion.Coronary artery bypass grafting has an adverse impact on lung functions and ABGs.

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“…В первой половине 1990 х годов вопросу РА были посвя щены многие исследования, показавшие, что сокращение вре мени ИВЛ и реорганизация послеоперационного ведения вполне безопасны для пациента и экономически обоснованы [62][63][64][65]. Одновременно ряд авторов подвергали сомнению це лесообразность активизации пациентов в ранние сроки после операций, указывая на потенциальную опасность такой лечеб ной тактики в ближайший послеоперационный период, отсут ствие ее влияния на сокращение сроков лечения в ОИТ, госпи тализации и финансовых затрат [66,67].…”

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Early Activation of Cardiosurgical Patients: History and Terminology (a review of literature)

Kozlov¹,

Дудов²,

Дзыбинская³

2010

rmt

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Анестезиолого реаниматологическую тактику, обеспе чивающую максимально быстрое прекращение искусственной вентиляции легких (ИВЛ) и экстубацию трахеи после опера ций с искусственным кровообращением (ИК), за рубежом рас сматривают как основной лечебный компонент так называе мой «быстрой кардиохирургии» («fast track cardiac surgery»), обеспечивающей, прежде всего, укорочение госпитализации больных, интенсификацию лечебного процесса и удешевление лечения [1-6]. В отечественной литературе такой методичес кий подход принято обозначать как раннюю активизацию (РА), имея в виду, что прекращение ИВЛ и экстубация трахеи являются ключевым моментом послеоперационного восста новления физической активности больных [7, 8]. РА стала предметом максимально оживленной научно клинической дискуссии на протяжении последних 10 лет [3, 6, 9], когда в англоязычной специальной литературе были опубли кованы результаты обширных доказательных исследований, в том числе аналитических обзоров, мета анализов и пр. [2, 4, 5, 10-12]. Благодаря этому создалось впечатление, что РА в кар диохирургии является новейшим методическим подходом, про тивопоставляемым традиционной тактике продленной ИВЛ. Например, в редакционной статье журнала Anesthesiology в 2003 г., профессор Калифорнийского университета в Сан Фран циско A. W. Wallace [6] задал вопрос: «Время ли переходить на

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Postoperative cardiac surgical care: an alternative approach

Abstract: episodic oxygen desaturation in the postoperative period: its association with ventilatory pattern and analgesic regimen.

Cited by 3 publications

References 5 publications

Lung ultrasound compared with chest X‐ray in diagnosing postoperative pulmonary complications following cardiothoracic surgery: a prospective observational study

Lung ultrasound compared with chest X‐ray in diagnosing postoperative pulmonary complications following cardiothoracic surgery: a prospective observational study

Effect of Coronary Artery Bypass Grafting Surgery on Pulmonary Function Tests and Arterial Blood Gases

Early Activation of Cardiosurgical Patients: History and Terminology (a review of literature)

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