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

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dc.contributor.authorBolzan, Douglas Willian [UNIFESP]
dc.contributor.authorGomes, Walter José [UNIFESP]
dc.contributor.authorRocco, Isadora Salvador [UNIFESP]
dc.contributor.authorViceconte, Marcela [UNIFESP]
dc.contributor.authorNasrala, Mara Lilian Soares [UNIFESP]
dc.contributor.authorPauletti, Hayanne Osiro [UNIFESP]
dc.contributor.authorMoreira, Rita Simone Lopes [UNIFESP]
dc.contributor.authorHossne Junior, Nelson Americo [UNIFESP]
dc.contributor.authorArena, Ross
dc.contributor.authorGuizilini, Solange [UNIFESP]
dc.contributor.institutionUniversidade Federal de São Paulo (UNIFESP)
dc.date.accessioned2019-01-21T10:29:40Z
dc.date.available2019-01-21T10:29:40Z
dc.date.issued2016
dc.description.abstractOBJECTIVE: 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.en
dc.description.affiliationDisciplina de Cirurgia Cardiovascular e Cardiologia da Escola Paulista de Medicina da Universidade de São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
dc.description.affiliationDepartamento de Ciência do Movimento Humana, Escola de Fisioterapia da Universidade Federal de São Paulo (UNIFESP), Santos, SP, Brazil
dc.description.affiliationDepartment of Physical Therapy and Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, USA
dc.description.affiliationUnifespDisciplina de Cirurgia Cardiovascular e Cardiologia da Escola Paulista de Medicina da Universidade de São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
dc.description.affiliationUnifespDepartamento de Ciência do Movimento Humana, Escola de Fisioterapia da Universidade Federal de São Paulo (UNIFESP), Santos, SP, Brazil
dc.description.sourceWeb of Science
dc.format.extent358-364
dc.identifierhttps://cdn.publisher.gn1.link/bjcvs.org/pdf/v31n5a06.pdf
dc.identifier.citationBrazilian Journal Of Cardiovascular Surgery. Sao paulo sp, v. 31, n. 5, p. 358-364, 2016.
dc.identifier.doi10.5935/1678-9741.20160057
dc.identifier.fileS0102-76382016000500358.pdf
dc.identifier.issn0102-7638
dc.identifier.scieloS0102-76382016000500358
dc.identifier.urihttps://repositorio.unifesp.br/handle/11600/49313
dc.identifier.wosWOS:000390092100006
dc.language.isoeng
dc.publisherDove Medical Press Ltd
dc.relation.ispartofBrazilian Journal Of Cardiovascular Surgery
dc.rightsinfo:eu-repo/semantics/openAccess
dc.subjectCoronary Artery Bypass, Off-Pumpen
dc.subjectRespiration, Artificialen
dc.subjectPositive-Pressure RespirationEnd-Expiratory Pressureen
dc.subjectPulmonary-Functionen
dc.subjectCardiopulmonary Bypassen
dc.subjectPleural Drainen
dc.subjectMyocardial Revascularizationen
dc.subjectSurgeryen
dc.subjectPleurotomyen
dc.subjectOxygenationen
dc.subjectMechanicsen
dc.subjectCapacityen
dc.titleEarly open-lung ventilation improves clinical outcomes in patients with left cardiac dysfunction undergoing off-pump coronary artery bypass: a randomized controlled trialen
dc.typeinfo:eu-repo/semantics/article
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