Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942012000500009
Brazilian Journal of Anesthesiology
Scientific Article

Influência da posição do dreno pleural na função pulmonar de pacientes submetidos à revascularização do miocárdio

Influence of pleural drain insertion in lung function of patients undergoing coronary artery bypass grafting

Irinea Beatriz Carvalho Ozelami Vieira; Fabiano F. Vieira; João Abrão; Ada Clarice Gastaldi

http://dx.doi.org/10.1590/S0034-70942012000500009 Braz J Anesthesiol, vol.62, n5, p.702-708, 2012
PDF Português
PDF English
Downloads: 0
Views: 949

Resumo

JUSTIFICATIVA E OBJETIVOS: Estudo longitudinal, prospectivo, aleatório e encoberto para avaliar a influência do local de inserção do dreno pleural, de PVC atóxico, na função pulmonar e na dor pós-operatória dos pacientes submetidos à revascularização do miocárdio nos três primeiros dias pós-cirúrgicos e logo após a retirada do dreno. PACIENTES E MÉTODOS: Trinta e seis pacientes escalados para cirurgia eletiva de revascularização do miocárdio, com uso de circulação extracorpórea (CEC), em dois grupos: grupo SX (dreno subxifoide) e grupo IC (dreno intercostal). Feitos registros espirométricos, da gasometria arterial e da dor. RESULTADOS: Trinta e um pacientes analisados, 16 no grupo SX e 15 no grupo IC. O grupo SX apresentou valores espirométricos maiores do que o grupo IC (p < 0,05) no pós-operatório (PO), denotando menor influência do local do dreno na respiração. A PaO2 arterial no segundo PO aumentou significantemente no grupo SX quando comparada com o grupo IC (p < 0,0188). A intensidade da dor no grupo SX, antes e após a espirometria, era menor do que no grupo IC (p < 0,005). Houve aumento significativo dos valores espirométricos em ambos os grupos após a retirada do dreno pleural. CONCLUSÃO: A inserção do dreno na região subxifoide altera menos a função pulmonar, provoca menos desconforto e possibilita uma melhor recuperação dos parâmetros respiratórios.

Palavras-chave

CIRURGIA, Cardíaca, COMPLICAÇÕES, Pneumotórax, DOR, Pós-operatória, TÉCNICAS DE MEDIÇÃO, Espirometria, Dor

Abstract

BACKGROUND AND OBJECTIVES: Longitudinal, prospective, randomized, blinded Trial to assess the influence of pleural drain (non-toxic PVC) site of insertion on lung function and postoperative pain of patients undergoing coronary artery bypass grafting in the first three days post-surgery and immediately after chest tube removal. METHOD: Thirty six patients scheduled for elective myocardial revascularization with cardiopulmonary bypass (CPB) were randomly allocated into two groups: SX group (subxiphoid) and IC group (intercostal drain). Spirometry, arterial blood gases, and pain tests were recorded. RESULTS: Thirty one patients were selected, 16 in SX group and 15 in IC group. Postoperative (PO) spirometric values were higher in SX than in IC group (p < 0.05), showing less influence of pleural drain location on breathing. PaO2 on the second PO increased significantly in SX group compared with IC group (p < 0.0188). The intensity of pain before and after spirometry was lower in SX group than in IC group (p < 0.005). Spirometric values were significantly increased in both groups after chest tube removal. CONCLUSION: Drain with insertion in the subxiphoid region causes less change in lung function and discomfort, allowing better recovery of respiratory parameters.

Keywords

Chest tubes, Coronary artery bypass grafting, Pneumothorax, Pain, Postoperative, Pain Measurement, Spirometry

References

Imura H, Caputo M, Lim K. Pulmonary injury after cardiopulmonary bypass: beneficial effects of low-frequency mechanical ventilation. J Thorac Cardiovasc Surg. 2009;137:1530-1537.

Pick A, Dearani J, Odell J. Effect of sternotomy direction on the incidence of inadvertent pleurotomy. J Cardiovasc Surg. 1998;39:673- 676.

Taggart DP, el-Fiky M, Carter R, Bowman A. Respiratory dysfunction after uncomplicated cardiopulmonary bypass. Ann Thorac Surg. 1993;56:1123-1128.

Hagl C, Harringer W, Gohrbandt B. Site of pleural drain insertion and early postoperative pulmonary function following coronary artery bypass grafting with internal mammary artery. Chest. 1999;115:757-761.

Peng MJ, Vargas FS, Cukier A. Postoperative Pleural Changes after Coronary Revascularization: Comparison between Saphenous- Vein and Internal Mammary Artery Grafting. Chest. 1992;101:327- 330.

Shapira N, Zabatino SM, Ahmed S. Determinants of pulmonary function in patients undergoing coronary bypass operations. Ann Thorac Surg. 1990;50:268-273.

Guizilini S, Gomes WJ, Faresin SM. Influence of pleurotomy on pulmonary function after off-pump coronary artery bypass grafting. Ann Thorac Surg. 2007;84:817-822.

Kollef MH, Peller T, Knodel A. Delayed pleuropulmonary complications following coronary artery revascularization with the internal mammary artery. Chest. 1988;94:68-71.

Vargas FS, Uezumi KK, Janete FB. Acute pleuropulmonary complications detected by computed tomography following myocardial revascularization. Rev Hosp Clin Fac Med São Paulo. 2002;57:135-142.

Guizilini S, Gomes WJ, Faresin SM. Effects of the pleural drain site on the pulmonary function after coronary artery bypass grafting. Rev Bras Cir Cardiovasc. 2004;19:47-54.

Bjessmo S, Hylander S, Vedin J. Comparison of three different chest drainages after coronary artery bypass surgery: A randomised trial in 150 patients. Eur J Cardiothorac Surg. 2007;31:372-375.

Frankel TL, Hill PC, Stamou SC. Silastic drains vs conventional chest tubes after coronary artery bypass. Chest. 2003;124:108-113.

Kollef MH, Dothager DW. Reversible cardiogenic shock due to chest tube compression of the right ventricle. Chest. 1991;99:976-980.

Castro Pereira CA. Espirometria em diretrizes para testes de função pulmonar 2002. J Bras Pneumol. 2002;28(^s3):S2-S82.

Eveleth PB, Andres R, Chumlea WC. Uses and interpretation of antrhropometry in the elderly for the assessment of physical status: Report to the Nutrition Unit of the World Health Organization: the Expert Subcommittee on the Use and Interpretation of Anthropometry in the Elderly. J Nutr Health Aging. 1998;2(1):5-17.

Oliveira MVC, Oliveira TR, Pereira CAC. Tabagismo em pacientes internados em um hospital geral. J Bras Pneumol. 2008;34:936- 941.

Berrizbeitia LD, Tessler S, Jacobowitz IJ. Effect of Sternotomy and Coronary-Bypass Surgery on Postoperative Pulmonary Mechanics: Comparison of Internal Mammary and Saphenous-Vein Bypass Grafts. Chest. 1989;96:873-876.

Singh NP, Vargas FS, Cukier A. Arterial blood gases after coronary artery bypass surgery. Chest. 1992;102:1337-1341.

Christenson JT, Aeberhard JM, Badel P. Adult respiratory distress syndrome after cardiac surgery. Cardiovasc Surg. 1996;4:15-21.

Taniguchi L, Pinheiro A. Particularidades do atendimento ao paciente em pós-operatório de cirurgia cardíaca. Fisioterapia em Cardiologia: Da UTI à Reabilitação. 2000:121-154.

Regan K, Kleinfeld M, Erik P. Fisioterapia para pacientes com cirurgia abdominal ou torácica. Fisioterapia cardiopulmonar. 1994:318-339.

Jenkins SC, Soutar SA, Forsyth A. Lung function after coronary artery surgery using the internal mammary artery and the saphenous vein. Thorax. 1989;44:209-211.

O'Brien JW, Johnson SH, VanSteyn SJ. Effects of internal mammary artery dissection on phrenic nerve perfusion and function. Ann Thorac Surg. 1991;52:182-188.

Brooks-Brunn JA. Postoperative atelectasis and pneumonia: risk factors. Am J Respir Crit Care Med. 1995;4:340-9.

Galantier J. Particularidades da circulação extracorpórea. Pós-operatório de cirurgia torácica e cardiovascular. 2004:153-157.

Cohen AJ, Moore P, Jones C. Effect of internal mammary harvest on postoperative pain and pulmonary function. Ann Thorac Surg. 1993;56:1107-1109.

Burgess GE, Cooper JR, Marino RJ. Pulmonary effect of pleurotomy during and after coronary artery bypass with internal mammary artery versus saphenous vein grafts. J Thorac Cardiovasc Surg. 1978;76:230-234.

Riebman JB, Olivenciayurvati AH, Laub GW. Improved Technique for Pleural Drain Insertion during Cardiovascular-Surgery. J Cardiovasc Surg. 1994;35:503-505.

Giacomazzi CM, Lagni VB, Monteiro MB. Postoperative pain as a contributor to pulmonary function impairment in patients submitted to heart surgery. Rev Bras Cir Cardiovasc. 2006;21:386-392.

Oikkonen M, Karjalainen K, Kahara V. Comparison of incentive spirometry and intermittent positive pressure breathing after coronary artery bypass graft. Chest. 1991;99:60-65.

Chon KS, vanSonnenberg E, D'Agostino HB, O'Laoide RM, Colt HG, Hart E. CT-guided catheter drainage of loculated thoracic air collections in mechanically ventilated patients with acute respiratory distress syndrome. Am J Roentgenol. 1999;173:1345-1350.

Lancey RA, Gaca C, Vander Salm TJ. The use of smaller, more flexible chest drains following open heart surgery: an initial evaluation. Chest. 2001;119:19-24.

Nunez R, Munoz JA, Vazquez F. Effects of several methods of thoracic drainage on respiratory function. Cir Pediatr. 1996;9:28-31.

Duggan M, Kavanagh BP. Pulmonary atelectasis: a pathogenic perioperative entity. Anesthesiology. 2005;102:838-854.

Wheatcroft M, Shrivastava V, Nyawo B. Does pleurotomy during internal mammary artery harvest increase post-operative pulmonary complications?. Interact Cardiovasc Thorac Surg. 2005;4:143-146.

Jakob H, Kamler M, Hagl S. Doubly angled pleural drain circumventing the transcostal route relieves pain after cardiac surgery. Thorac Cardiovasc Surg. 1997;45:263-264.

Gómez-Caro A, Roca MJ, Torres J. Successful use of a single chest drain post-lobectomy instead of two classical drains: a randomized study. Eur J Cardiothorac Surg. 2006;29:562-566.

Mueller XM, Tinguely F, Tevaearai HT. Impact of duration of chest tube drainage on pain after cardiac surgery. Eur J Cardiothorac Surg. 2000;18:570-574.

Lima VP, Bonfim D, Risso TT. Influence of pleural drainage on postoperative pain, vital capacity and six-minute walk test after pulmonary resection. J Bras Pneumol. 2008;34:1003-1007.

5dd29e1d0e8825c34bc63494 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections