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Title: Early open-lung ventilation improves clinical outcomes in patients with left cardiac dysfunction undergoing off-pump coronary artery bypass: a randomized controlled trial
Authors: Bolzan, Douglas W. [UNIFESP]
Gomes, Walter Jose [UNIFESP]
Rocco, Isadora S. [UNIFESP]
Viceconte, Marcela [UNIFESP]
Nasrala, Mara L. S. [UNIFESP]
Pauletti, Hayanne O. [UNIFESP]
Moreira, Rita Simone L. [UNIFESP]
Hossne, Nelson A., Jr. [UNIFESP]
Arena, Ross
Guizilini, Solange [UNIFESP]
Keywords: Coronary Artery Bypass, Off-Pump
Respiration, Artificial
Positive-Pressure RespirationEnd-Expiratory Pressure
Cardiopulmonary Bypass
Pleural Drain
Myocardial Revascularization
Issue Date: 2016
Publisher: Dove Medical Press Ltd
Citation: Brazilian Journal Of Cardiovascular Surgery. Sao paulo sp, v. 31, n. 5, p. 358-364, 2016.
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.
ISSN: 0102-7638
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