Abstract
To assess the ventilatory, radiological and clinical profile of patients undergoing elective CABG in a cardiology reference hospital in South Brazil. This study included 108 patients undergoing elective CABG surgery, in the period between April 2006 and February 2007 at the Cardiology Institute of Rio Grande do Sul (IC-FUC). The surgical procedure involved median sternotomy, and the saphenous vein and/or internal mammary artery were used for grafting. Lung volume and capacity, as well as the possible existence of ventilatory changes, were assessed by spirometry, and the ventilatory muscle strength was assessed using a vaccum manometer. All evaluations were performed on the preoperative period and on the sixth postoperative day. Preoperative levels of FEV1 and FVC were significantly reduced on the 6th postoperative day (P<0.001) when compared to the preoperative levels. A significant decrease of ventilatory muscle strength, expressed as maximum inspiratory and expiratory pressures (MIP and MEP), was also observed from the pre- to the sixth postoperative day (P<0.001). Pulmonary events were more frequent on the 6th postoperative day (78%) than on the 1st postoperative day (40%). Patients undergone CABG surgery present important reduction in pulmonary volume and capacity, as well as on the ventilatory muscle strength during the postoperative period.
Highlights
Since 1965, numerous studies have been performed attempting to achieve the relation of heart diseases with respiratory system and their influence on it, noting that the cardiac commitment and the surgical procedure determine pulmonary complications, one of the most common causes of morbidity and mortality in the postoperative period of heart surgery [1,2,3].General anesthesia, surgical incision, cardiopulmonary bypass (CPB), ischemia time, intensity of the surgical manipulation and number of pleural drains may predispose the patient to the change in lung function [1,2,4,5,6]
The use of CPB and absence of pulmonary ventilation during this period are determining factors in the development of pulmonary complications after heart surgery, probably by changes in mechanical properties of the respiratory system resulting from changes in pulmonary compliance and resistance [8,9]
Patients follow-up consisted of information of the characteristics of the surgical procedure, postoperative pulmonary complications through the radiology Service, evaluation of lung volume and capacity, evaluation of the ventilatory disorder, evaluation of ventilatory muscle strength and clinical evolution of patients until the hospital discharge
Summary
Since 1965, numerous studies have been performed attempting to achieve the relation of heart diseases with respiratory system and their influence on it, noting that the cardiac commitment and the surgical procedure determine pulmonary complications, one of the most common causes of morbidity and mortality in the postoperative period of heart surgery [1,2,3].General anesthesia, surgical incision, cardiopulmonary bypass (CPB), ischemia time, intensity of the surgical manipulation and number of pleural drains may predispose the patient to the change in lung function [1,2,4,5,6]. Since 1965, numerous studies have been performed attempting to achieve the relation of heart diseases with respiratory system and their influence on it, noting that the cardiac commitment and the surgical procedure determine pulmonary complications, one of the most common causes of morbidity and mortality in the postoperative period of heart surgery [1,2,3]. The median sternotomy, the most used approach to the procedure of CABG surgery, promotes significant changes in pulmonary function by the consequent instability of the upper chest and leads to changes in mechanical ventilation and ineffective coughing [7]. The use of CPB and absence of pulmonary ventilation during this period are determining factors in the development of pulmonary complications after heart surgery, probably by changes in mechanical properties of the respiratory system resulting from changes in pulmonary compliance and resistance [8,9]. With establishment of off-pump CABG surgery, this idea begins to be questioned, since the lung damages are considerable with such surgery [5]
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