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

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dc.contributor.authorGuizilini, Solange [UNIFESP]
dc.contributor.authorBolzan, Douglas W. [UNIFESP]
dc.contributor.authorFaresin, Sonia M. [UNIFESP]
dc.contributor.authorFerraz, Raquel F. [UNIFESP]
dc.contributor.authorTavolaro, Kelly [UNIFESP]
dc.contributor.authorCancio, Andrea A. [UNIFESP]
dc.contributor.authorGomes, Walter J. [UNIFESP]
dc.contributor.institutionUniversidade Federal de São Paulo (UNIFESP)
dc.date.accessioned2016-01-24T14:17:49Z
dc.date.available2016-01-24T14:17:49Z
dc.date.issued2012-01-25
dc.description.abstractBackground: 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.en
dc.description.affiliationUniversidade Federal de São Paulo, Escola Paulista Med, Pirajussara Hosp, Dept Med,Cardiol Discipline, BR-04024002 São Paulo, Brazil
dc.description.affiliationUniversidade Federal de São Paulo, Escola Paulista Med, São Paulo Hosp, Dept Med,Cardiol Discipline, BR-04024002 São Paulo, Brazil
dc.description.affiliationUniversidade Federal de São Paulo, Physiotherapy Sch, Dept Human Movement Sci, BR-11060001 Santos, Brazil
dc.description.affiliationUniversidade Federal de São Paulo, Escola Paulista Med, São Paulo Hosp, Dept Med,Pneumol Discipline, BR-04039002 São Paulo, Brazil
dc.description.affiliationUniversidade Federal de São Paulo, Escola Paulista Med, Pirajussara Hosp, Dept Med,Cardiovasc Surg Discipline, BR-04024002 São Paulo, Brazil
dc.description.affiliationUniversidade Federal de São Paulo, Escola Paulista Med, São Paulo Hosp, Dept Med,Cardiovasc Surg Discipline, BR-04024002 São Paulo, Brazil
dc.description.affiliationUnifespUniversidade Federal de São Paulo, Escola Paulista Med, Pirajussara Hosp, Dept Med,Cardiol Discipline, BR-04024002 São Paulo, Brazil
dc.description.affiliationUnifespUniversidade Federal de São Paulo, Escola Paulista Med, São Paulo Hosp, Dept Med,Cardiol Discipline, BR-04024002 São Paulo, Brazil
dc.description.affiliationUnifespUniversidade Federal de São Paulo, Physiotherapy Sch, Dept Human Movement Sci, BR-11060001 Santos, Brazil
dc.description.affiliationUnifespUniversidade Federal de São Paulo, Escola Paulista Med, São Paulo Hosp, Dept Med,Pneumol Discipline, BR-04039002 São Paulo, Brazil
dc.description.affiliationUnifespUniversidade Federal de São Paulo, Escola Paulista Med, Pirajussara Hosp, Dept Med,Cardiovasc Surg Discipline, BR-04024002 São Paulo, Brazil
dc.description.affiliationUnifespUniversidade Federal de São Paulo, Escola Paulista Med, São Paulo Hosp, Dept Med,Cardiovasc Surg Discipline, BR-04024002 São Paulo, Brazil
dc.description.sourceWeb of Science
dc.format.extent7
dc.identifierhttp://dx.doi.org/10.1186/1749-8090-7-11
dc.identifier.citationJournal of Cardiothoracic Surgery. London: Biomed Central Ltd, v. 7, 7 p., 2012.
dc.identifier.doi10.1186/1749-8090-7-11
dc.identifier.fileWOS000300890000001.pdf
dc.identifier.issn1749-8090
dc.identifier.urihttp://repositorio.unifesp.br/handle/11600/34536
dc.identifier.wosWOS:000300890000001
dc.language.isoeng
dc.publisherBiomed Central Ltd
dc.relation.ispartofJournal of Cardiothoracic Surgery
dc.rightsinfo:eu-repo/semantics/openAccess
dc.subjectOff pump coronary artery bypass graftingen
dc.subjectInternal thoracic arteryen
dc.subjectPleurotomyen
dc.subjectPulmonary functionen
dc.subjectPleural drainen
dc.subjectPainen
dc.titlePleurotomy with subxyphoid pleural drain affords similar effects to pleural integrity in pulmonary function after off-pump coronary artery bypass graften
dc.typeinfo:eu-repo/semantics/article
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