Postoperative Pleural Changes after Coronary Revascularization

Peng, Ming-Jen; Vargas, Francisco S.; Cukier, Alberto; Filho, Mário Terra; Teixeira, Lisete R.; Light, Richard W.

doi:10.1378/chest.101.2.327

Cited by 83 publications

(25 citation statements)

References 14 publications

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“…Confirming existing findings, this study demonstrated that there is deterioration in the pulmonary function in the postoperative period of CABG surgery with the use of LITA grafts and left pleurotomy [3]. The reduction in the pulmonary function is the result of the combination of several factors, including the general anesthesia, median sternotomy, cardiopulmonary bypass (CPB) [2] and diaphragmatic dysfunction [10].…”

Section: Discussionsupporting

confidence: 82%

“…The reduction in the pulmonary function is the result of the combination of several factors, including the general anesthesia, median sternotomy, cardiopulmonary bypass (CPB) [2] and diaphragmatic dysfunction [10]. As well as these, there is the additional factor of the pleural drainage required because of the use of LITA grafts with pleurotomy [3,11]. Previous studies demonstrated that, independent of the surgical technique utilized, CPB causes pulmonary injury and retards recovery of the respiratory function [12].…”

Section: Discussionmentioning

confidence: 99%

“…This greater drop in the pulmonary function observed by the insertion of the pleural drain in the intercostal space occurs because it causes more injury to the thorax, perforating the parietal pleura and the intercostal muscles [3,5]. JAKOB et al [4] showed that the high sensitivity of the pleura and the friction produced during respiratory movement provoke suffering to the patient, by constant irritation of the intercostal and periosteo-nerves.…”

Section: Discussionmentioning

confidence: 99%

“…However, in the majority of the procedures, the attainment of the LITA pedicle involves opening the left pleural cavity, which subsequently requires draining. This pleurotomy, associated with the presence of a pleural drain, contributes to the discomfort of the patient, functioning as an additional factor in deteriorating the respiratory mechanics [2,3].…”

Section: Introductionmentioning

confidence: 99%

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<![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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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

<![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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“…Ineffective homoeostasis control, fibrinolysis, insufficiency in lymphatic drainage, pericardial inflammation, postpericardiotomy syndrome,1 and left internal mammary artery (LIMA) harvesting with pleurotomy lead to pleural and pericardial effusions after coronary artery bypass grafting (CABG) surgery 23. Hematomas of the mediastinum or thorax must be drained efficiently to reduce mortality and morbidity rates.…”

mentioning

confidence: 99%

Computed tomography evaluation of different chest tube sites for residual pleural volumes after coronary artery bypass surgery

Sensoz

Günay

Tuygun

et al. 2011

Annals of Saudi Medicine

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BACKGROUND AND OBJECTIVES:We investigated the efficacy of pleural drainage with the use of different chest tube methods in patients after coronary artery bypass graft (CABG) surgery.DESIGN AND SETTING:Prospective randomized study of 60 patients undergoing elective on-pump single CABG surgery.PATIENTS AND METHODS:The left internal mammary arterial grafts were harvested from all patients. The patients were separated into three groups: In one group (IC6, n=20), pleural tubes were inserted through the sixth intercostal space at the midaxillary line; in the second group (SX-r, n=20), rigid straight pleural tubes were inserted from the mediastinum through the subxiphoid area; and in the third group (SX-s, n=20), soft curved drainage tubes were inserted from the mediastinum through the subxiphoid area. The residual pleural effusion was examined by multislice CT scans within 8 hours of removal of the drainage tubes. Pain was evaluated according to standard methods.RESULTS:The groups did not differ with respect to volume of residual pleural effusion (P>.05). The IC6 group had a higher mean pain score than the other two groups (P<.05), whose mean pain scores did not differ significantly from each other (P>.05). IC6 group patients had a higher requirement for analgesics. The rate of atelectasis was higher in group IC6 (P<.05).CONCLUSION:CT scans revealed that different chest tube insertion sites have the same efficiency for draining of pleural effusion, although drainage tubes inserted through the thoracic cage may result in more severe pain.

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Pleural Fluid Characteristics of Patients With Symptomatic Pleural Effusion After Coronary Artery Bypass Graft Surgery

et al. 2000

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Postoperative Pleural Changes after Coronary Revascularization

Cited by 83 publications

References 14 publications

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

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

Computed tomography evaluation of different chest tube sites for residual pleural volumes after coronary artery bypass surgery

Pleural Fluid Characteristics of Patients With Symptomatic Pleural Effusion After Coronary Artery Bypass Graft Surgery

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