Solange Guizilini1, Daniel F Alves2, Douglas W Bolzan2, Andreia S A Cancio2, Marisa M Regenga2, Rita S L Moreira2, Renata Trimer3, Walter J Gomes2. 1. Cardiology and Cardiovascular Surgery Discipline, Federal University of São Paulo, São Paulo, Brazil Department of Human Motion Sciences, Physical Therapy School - Federal University of São Paulo, São Paulo, Brazil sguizilini@unifesp.br. 2. Cardiology and Cardiovascular Surgery Discipline, Federal University of São Paulo, São Paulo, Brazil. 3. Cardiopulmonary Physiotherapy Laboratory, Nucleus of Research in Physical Exercise, Federal University of São Carlos, São Paulo, Brazil.
Abstract
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.
RCT Entities:
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.
Authors: Mara L S Nasrala; Douglas W Bolzan; Yumi G Lage; Fabiana S Prado; Ross Arena; Paulo R L Lima; Gibran Feguri; Ageo M C Silva; Natasha O Marcondi; Nelson Hossne; Solange Guizilini; Walter J Gomes Journal: Braz J Cardiovasc Surg Date: 2018 May-Jun
Authors: Douglas W Bolzan; Walter José Gomes; Isadora S Rocco; Marcela Viceconte; Mara L S Nasrala; Hayanne O Pauletti; Rita Simone L Moreira; Nelson A Hossne; Ross Arena; Solange Guizilini Journal: Braz J Cardiovasc Surg Date: 2016 Sep-Oct
Authors: Débora Santos de Oliveira Gomes; Elzane Jesus de Almeida Silva; Josimar Silva E Silva; Hayssa de Cássia Mascarenhas Barbosa; André Raimundo Guimarães; André Luiz Lisboa Cordeiro Journal: Braz J Anesthesiol Date: 2021-07-05