Sub-xyphoid pleural drain as a determinant of functional capacity and clinical results after off-pump coronary artery bypass surgery: a randomized clinical trial

dc.contributor.authorGuizilini, Solange [UNIFESP]
dc.contributor.authorAlves, Daniel F. [UNIFESP]
dc.contributor.authorBolzan, Douglas Willian [UNIFESP]
dc.contributor.authorCancio, Andreia da Silva Azevedo [UNIFESP]
dc.contributor.authorRegenga, Marisa de Moraes [UNIFESP]
dc.contributor.authorMoreira, Rita Simone Lopes [UNIFESP]
dc.contributor.authorTrimer, Renata [UNIFESP]
dc.contributor.authorGomes, Walter José [UNIFESP]
dc.contributor.institutionUniversidade Federal de São Paulo (UNIFESP)
dc.date.accessioned2016-01-24T14:37:45Z
dc.date.available2016-01-24T14:37:45Z
dc.date.issued2014-09-01
dc.description.abstractOBJECTIVES: 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.en
dc.description.affiliationUniversidade Federal de São Paulo, Cardiol & Cardiovasc Surg Discipline, BR-04023900 São Paulo, Brazil
dc.description.affiliationUniversidade Federal de São Paulo, Phys Therapy Sch, Dept Human Mot Sci, BR-04023900 São Paulo, Brazil
dc.description.affiliationUniversidade Federal de São Paulo, Cardiopulm Physiotherapy Lab, BR-04023900 São Paulo, Brazil
dc.description.affiliationUnifespUniversidade Federal de São Paulo, Cardiol & Cardiovasc Surg Discipline, BR-04023900 São Paulo, Brazil
dc.description.affiliationUnifespUniversidade Federal de São Paulo, Phys Therapy Sch, Dept Human Mot Sci, BR-04023900 São Paulo, Brazil
dc.description.affiliationUnifespUniversidade Federal de São Paulo, Cardiopulm Physiotherapy Lab, BR-04023900 São Paulo, Brazil
dc.description.sourceWeb of Science
dc.format.extent382-387
dc.identifierhttps://dx.doi.org/10.1093/icvts/ivu138
dc.identifier.citationInteractive Cardiovascular and Thoracic Surgery. Oxford: Oxford Univ Press, v. 19, n. 3, p. 382-387, 2014.
dc.identifier.doi10.1093/icvts/ivu138
dc.identifier.issn1569-9293
dc.identifier.urihttps://repositorio.unifesp.br/handle/11600/38121
dc.identifier.wosWOS:000343318700007
dc.language.isoeng
dc.publisherOxford Univ Press
dc.relation.ispartofInteractive Cardiovascular and Thoracic Surgery
dc.rightsAcesso aberto
dc.rights.licensehttp://www.oxfordjournals.org/access_purchase/self-archiving_policyb.html
dc.subjectCoronary artery bypass graftsen
dc.subjectFunctional capacityen
dc.subjectRehabilitationen
dc.subjectPleurotomyen
dc.titleSub-xyphoid pleural drain as a determinant of functional capacity and clinical results after off-pump coronary artery bypass surgery: a randomized clinical trialen
dc.typeArtigo
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