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

Author Bolzan, Douglas W. Autor UNIFESP Google Scholar
Gomes, Walter Jose Autor UNIFESP Google Scholar
Rocco, Isadora S. Autor UNIFESP Google Scholar
Viceconte, Marcela Autor UNIFESP Google Scholar
Nasrala, Mara L. S. Autor UNIFESP Google Scholar
Pauletti, Hayanne O. Autor UNIFESP Google Scholar
Moreira, Rita Simone L. Autor UNIFESP Google Scholar
Hossne, Nelson A., Jr. Autor UNIFESP Google Scholar
Arena, Ross Google Scholar
Guizilini, Solange Autor UNIFESP Google Scholar
Abstract Objective: To 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). Methods: Sixty-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 (PaO 2) 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. Results: Both 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 PaO 2 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. Conclusion: Both 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.
Keywords Coronary Artery Bypass, Off-Pump
Respiration, Artificial
Positive-Pressure RespirationEnd-Expiratory Pressure
Pulmonary-Function
Cardiopulmonary Bypass
Pleural Drain
Myocardial Revascularization
Surgery
Pleurotomy
Oxygenation
Mechanics
Capacity
Language English
Date 2016
Published in Brazilian Journal Of Cardiovascular Surgery. Sao paulo sp, v. 31, n. 5, p. 358-364, 2016.
ISSN 0102-7638 (Sherpa/Romeo, impact factor)
Publisher Dove Medical Press Ltd
Extent 358-364
Origin http://dx.doi.org/10.5935/1678-9741.20160057
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000390092100006
SciELO ID S0102-76382016000500358 (statistics in SciELO)
URI http://repositorio.unifesp.br/handle/11600/49313

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