Navegando por Palavras-chave "Pleurotomy"

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    Early open-lung ventilation improves clinical outcomes in patients with left cardiac dysfunction undergoing off-pump coronary artery bypass: a randomized controlled trial
    (Dove Medical Press Ltd, 2016) Bolzan, Douglas Willian [UNIFESP]; Gomes, Walter José [UNIFESP]; Rocco, Isadora Salvador [UNIFESP]; Viceconte, Marcela [UNIFESP]; Nasrala, Mara Lilian Soares [UNIFESP]; Pauletti, Hayanne Osiro [UNIFESP]; Moreira, Rita Simone Lopes [UNIFESP]; Hossne Junior, Nelson Americo [UNIFESP]; Arena, Ross; Guizilini, Solange [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    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 (PaO2) 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 PaO2 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.
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    Pleurotomy with subxyphoid pleural drain affords similar effects to pleural integrity in pulmonary function after off-pump coronary artery bypass graft
    (Biomed Central Ltd, 2012-01-25) Guizilini, Solange [UNIFESP]; Bolzan, Douglas W. [UNIFESP]; Faresin, Sonia M. [UNIFESP]; Ferraz, Raquel F. [UNIFESP]; Tavolaro, Kelly [UNIFESP]; Cancio, Andrea A. [UNIFESP]; Gomes, Walter J. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    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.
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    Sub-xyphoid pleural drain as a determinant of functional capacity and clinical results after off-pump coronary artery bypass surgery: a randomized clinical trial
    (Oxford Univ Press, 2014-09-01) Guizilini, Solange [UNIFESP]; Alves, Daniel F. [UNIFESP]; Bolzan, Douglas Willian [UNIFESP]; Cancio, Andreia da Silva Azevedo [UNIFESP]; Regenga, Marisa de Moraes [UNIFESP]; Moreira, Rita Simone Lopes [UNIFESP]; Trimer, Renata [UNIFESP]; Gomes, Walter José [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVES: the aim of this trial was to compare functional capacity, pulmonary shunt fraction and clinical outcomes between patients undergoing pleurotomy with a pleural drain inserted in the sub-xyphoid position and patients with a pleural drain placed in the intercostal position after off-pump coronary artery bypass surgery.METHODS: Patients were randomized into two groups according to the pleural drain site: Group II (n = 33 intercostal pleural drain); and Group SI (n = 35 sub-xyphoid pleural drain). Functional capacity was assessed by the distance covered on the 6-min walking test performed preoperatively and on postoperative day (POD) 5; in addition, pulmonary function test was determined preoperatively and on POD 1 and 5. Pulmonary shunt fraction was evaluated preoperatively and on POD 1, and clinical outcomes were recorded throughout the study.RESULTS: Group SI had better preservation of lung volumes and capacities in POD compared with Group II (P < 0.05). Pulmonary shunt fraction increased in both groups postoperatively; however, Group SI showed a smaller pulmonary shunt fraction (0.26 +/- 0.04 vs 0.21 +/- 0.04%; P = 0.0014). Functional capacity was significantly reduced in both groups on POD 5; however, Group SI showed better preservation of functional capacity (P = 0.0001). Group SI had better postoperative clinical results, with lower incidence of atelectasis and pleural effusion (P < 0.05), lower pain scores (P < 0.0001), and shorter orotracheal intubation and hospitalization lengths (P < 0.001).CONCLUSIONS: Sub-xyphoid pleural drain determined better functional capacity and exercise tolerance with a smaller pulmonary shunt fraction and improved clinical outcomes compared with intercostal pleural drainage after off-pump coronary artery bypass surgery.