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

Journal of Cardiothoracic Surgery

Walter J Gomes¹  Andrea A Cancio²  Kelly Tavolaro¹  Raquel F Ferraz¹  Sonia M Faresin³  Douglas W Bolzan²  Solange Guizilini⁴ 

[1] Department of Medicine, Cardiovascular Surgery Discipline, Pirajussara and São Paulo Hospitals, Escola Paulista de Medicina, Federal University of Sao Paulo, (Napoleao de Barros, 715), Sao Paulo, (04024-002), Brazil;Department of Medicine, Cardiology Discipline, Pirajussara and São Paulo Hospitals, Escola Paulista de Medicina, Federal University of Sao Paulo, (Napoleao de Barros, 715), Sao Paulo, (04024-002), Brazil;Department of Medicine, Pneumology Discipline, São Paulo Hospital, Escola Paulista de Medicina, Federal University of Sao Paulo, (Pedro de Toledo, 720), Sao Paulo, (04039-002), Brazil;Department of Human Movement Sciences, Physiotherapy School, Federal University of Sao Paulo, (Ana Costa, 95), Santos, (11060-001), Brazil

关键词: Pain.;    Pleural drain;    Pulmonary function;    Pleurotomy;    Internal thoracic artery;    Off pump coronary artery bypass grafting;   

Others  :  1153460
DOI  :  10.1186/1749-8090-7-11

 received in 2011-10-25, accepted in 2012-01-25,  发布年份 2012

【 摘 要 】

Background

Exacerbation 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).

Methods

Seventy-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.

Results

In 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.

Conclusion

Subxyphoid 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.

【 授权许可】

   
2012 Guizilini et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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