Lung Function before and Two Days after Open-Heart Surgery

Charlotte Urell,Margareta Emtner,Elisabeth Westerdahl,Christer Janson,Hans Hedenström

doi:10.1155/2012/291628

Charlotte Urell, Margareta Emtner + Show 3 more

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https://doi.org/10.1155/2012/291628

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Abstract

Reduced lung volumes and atelectasis are common after open-heart surgery, and pronounced restrictive lung volume impairment has been found. The aim of this study was to investigate factors influencing lung volumes on the second postoperative day. Open-heart surgery patients (n = 107, 68 yrs, 80% male) performed spirometry both before surgery and on the second postoperative day. The factors influencing postoperative lung volumes and decrease in lung volumes were investigated with univariate and multivariate analyses. Associations between pain (measured by numeric rating scale) and decrease in postoperative lung volumes were calculated with Spearman rank correlation test. Lung volumes decreased by 50% and were less than 40% of the predictive values postoperatively. Patients with BMI >25 had lower postoperative inspiratory capacity (IC) (33 ± 14% pred.) than normal-weight patients (39 ± 15% pred.), (P = 0.04). More pain during mobilisation was associated with higher decreases in postoperative lung volumes (VC: r = 0.33, P = 0.001; FEV1: r = 0.35, P ≤ 0.0001; IC: r = 0.25, P = 0.01). Patients with high BMI are a risk group for decreased postoperative lung volumes and should therefore receive extra attention during postoperative care. As pain is related to a larger decrease in postoperative lung volumes, optimal pain relief for the patients should be identified.

Highlights

Reductions in lung volumes and oxygenation are common during the initial period after open-heart surgery
More pain during mobilisation was associated with higher decreases in postoperative lung volumes (VC: r = 0.33, P = 0.001; forced expiratory volume in 1 second (FEV1): r = 0.35, P ≤ 0.0001; inspiratory capacity (IC): r = 0.25, P = 0.01)
On the second postoperative day, a mean reduction of 63% in vital capacity (VC), compared to preoperative values, is reported, and lung volumes can remain depleted for three-to-four months after surgery [6,7,8]

Summary

Introduction

Reductions in lung volumes and oxygenation are common during the initial period after open-heart surgery. In comparison to preoperative values, a mean reduction of forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) are reported to be 40–50% on the firstto-third postoperative days [5]. On the second postoperative day, a mean reduction of 63% in vital capacity (VC), compared to preoperative values, is reported, and lung volumes can remain depleted for three-to-four months after surgery [6,7,8]. Postoperative atelectasis are common in all patients undergoing open-heart surgery and the reduced lung volumes contribute to impaired gas exchange [9]. An inverse correlation between atelectatic area and arterial oxygenation (PaO2) is reported on the first [10] and second [11] postoperative days after open-heart surgery. Chronic obstructive pulmonary disease (COPD), general health status, smoking history, and age are factors associated with increased risk for impaired lung volume after surgery [12, 13]

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