1
|
El-Akkawi AI, Media AS, Eykens Hjørnet N, Nielsen DV, Modrau IS. Timing of Chest Tube Removal Following Adult Cardiac Surgery: A Cluster Randomized Controlled Trial. SCAND CARDIOVASC J 2024; 58:2294681. [PMID: 38112193 DOI: 10.1080/14017431.2023.2294681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/09/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVES Early chest tube removal following cardiac surgery may be associated with an increased risk of pleural or pericardial effusions following cardiac surgery. This study compares the effects of two fast-track chest tube removal protocols regarding the risk of pleural or pericardial effusions, requirement of opioids, respiratory function, and postoperative complications. DESIGN Prospective non-blinded cluster-randomized study with alternating chest tube removal protocol in adult patients undergoing elective cardiac surgery. Monthly changing allocation to scheduled chest tube removal on the day of surgery (Day 0) versus removal on the 1st postoperative day (Day 1) provided no air leakage and output < 200 mL within the last four hours. RESULTS A total of 527 patients were included in the study from September 1st 2020 until October 29th 2021 and randomly allocated to chest tube removal at day 0 (n = 255), and day 1 (n = 272). More than every fourth patient required drainage for pleural effusion with no significant difference between the groups. Earlier removal of chest tubes did not reduce requirement of analgesics, improve early respiratory function, or reduce postoperative complications. The study was halted for futility after halfway interim analysis showed insufficient promise of any treatment benefit. CONCLUSION Fast-track protocols with chest tube removal within the first 24 h after cardiac surgery may be associated a high rate of pleural effusions.
Collapse
Affiliation(s)
- Ali Imad El-Akkawi
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Ara Shwan Media
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Eykens Hjørnet
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Dorthe Viemose Nielsen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Ivy Susanne Modrau
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
2
|
Hatefi F, Kazemi M, Manglian P, Shahi Moridi D, Heydari S, Hasani H. The effects of cold compress and transcutaneous electrical nerve stimulation on the pain associated with chest tube removal among patients with coronary bypass grafting. J Cardiothorac Surg 2023; 18:186. [PMID: 37231409 DOI: 10.1186/s13019-023-02182-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 03/12/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND AND AIM Chest tube removal (CTR) can cause severe acute pain which is usually described by patients as a painful experience. This study compared the effects of cold compress, transcutaneous electrical nerve stimulation (TENS), and combined cold compress-TENS on CTR-associated pain among patients with coronary artery bypass grafting (CABG). METHODS This randomized controlled trial was conducted in 2018-2019 using a double-blind four-group design. Participants were 120 patients with CABG selected from Shafa hospital, Kerman, Iran, and randomly allocated to a cold compress, a TENS, a combined cold compress-TENS, and a placebo group (compress with room temperature) and TENS with an off TENS device. Each participant received the intervention for 15 min immediately before CTR. CTR-associated pain was assessed before, during, immediately after, and 15 min after CTR. Data were analyzed using the SPSS program (v. 22.0) at a significance level of less than 0.05. RESULTS The data of 29 participants in the placebo group, 26 in the TENS group, 30 in the cold compress group, and 26 in the combined cold compress-TENS group was gathered. Baseline demographic and clinical characteristics and pain intensity scores of participants had no statistically significant differences among all four groups (P > 0.05). The mean score of pain intensity in all groups was at its highest level during CTR and gradually decreased afterwards, but this pain intensity reduction in the compress-TENS group was significantly greater than other groups (P < 0.001). CONCLUSION Combined cold compress-TENS is more effective than separate cold compress and TENS in reducing CTR-associated pain among patients with CABG. Therefore, non-pharmacological methods such as combined cold compress-TENS are recommended for managing CTR-associated pain.
Collapse
Affiliation(s)
- Fatemeh Hatefi
- Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Majid Kazemi
- Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Non-Communicable Disease Research Center, Rafsanjan University of Medical Sciences, Nurse Street, Rafsanjan, Iran.
| | - Parvin Manglian
- Department of Critical Care Nursing, Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Dadullah Shahi Moridi
- Department of Basic Science, Faculty of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Shahin Heydari
- Department of Fundamental Nursing, Geriatric Care Research Center, Faculty of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Hadi Hasani
- Department of Medical Surgical Nursing, Jovein School of Nursing, Sabzevar University of Medical Sciences, Sabzevar, Iran
| |
Collapse
|
3
|
Early removal of chest drains in patients following off-pump coronary artery bypass graft (OPCAB) is not inferior to standard care - study in the Enhanced Recovery After Surgery (ERAS) group. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 18:71-74. [PMID: 34386046 PMCID: PMC8340633 DOI: 10.5114/ms.2021.107466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/06/2021] [Indexed: 11/17/2022]
Abstract
Introduction Only a few studies have concerned the timing of chest drains’ removal in cardiac surgery patients following the coronary artery bypass graft (CABG). None of them pertained to the off-pump CABG (OPCAB) procedure. Aim To compare thoracic drainage time in OPCAB patients before the implementation of the institutional Enhanced Recovery After Surgery (ERAS) protocol and after that. Material and methods It was a single-center observational study concerning patients following OPCAB. Two groups of patients were analyzed: after implementing the ERAS protocol, the ERAS group, and before this period, the standard care group (STAND group). The primary outcome of this study was to compare postoperative drainage time in the ERAS and STAND groups. The other outcomes included comparing transfused blood products, postoperative complications, surgical technique, postoperative ventilation and the intensive care unit stay time. Results Sixty patients in the ERAS and 112 in the STAND group were analyzed. The postoperative drainage time was shorter in the ERAS than in the STAND group: 20 (17–22) vs. 30 (27–35) h, p < 0.001. The number of transfused blood products was similar in both groups. No difference was noted between groups according to surgery and anesthesia time. However, patients in the ERAS group were ventilated for a significantly shorter time after the surgery and spent less time in the ICU than the STAND group. The number of postoperative complications in the ERAS and STAND group was 14 and 27, p = 1. Conclusions The early removal of chest drains after OPCAB does not increase the risk of postoperative complications and demand for blood products. However, its impact on patients’ morbidity needs further studies.
Collapse
|
4
|
Right pericardial window opening: a method of preventing pericardial effusion. Gen Thorac Cardiovasc Surg 2019; 68:485-491. [PMID: 31559587 DOI: 10.1007/s11748-019-01213-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 09/14/2019] [Indexed: 10/25/2022]
Abstract
AIM In this study, we aimed to investigate the superiority of right pericardial window (RPW) versus posterior pericardial drain placing for the parameters of pericardial effusion and the postoperative complications at the patients who has undergone cardiac surgery. MATERIALS AND METHODS Between July and September 2018, 120 adult patients (mean age 50.30 ± 14.61) who underwent cardiac surgery without the necessity of opening the pleura were included in the study. In Group 1, the RPW was opened (n = 60), and Group 2 posterior pericardial drainage tube was placed without RPW (n = 60). Risk factors and postoperative complication were evaluated and compared between the Groups. RESULTS Cardiac tamponade occurrence was not significantly different between the Groups (Group 1, n = 0 and Group 2, n = 3, p = 0.079). Postoperative transthoracic echocardiographic controls revealed significant pericardial effusion in Group 2 (6.90 mm ± 13.02 mm) compared to Group 1 (2.30 mm ± 5.60 mm) (p = 0.013). Postoperative creatinine levels were 0.75 ± 0.26 in Group 1 and 0.88 ± 0.36 in Group 2 (p = 0.022). A significant decrease in glomerular filtration rate was observed in Group 2 (102.7 ± 24.5 and 91.2 ± 28, p = 0.019). Postoperative acute renal failure was significantly higher in Group 2 compared to Group 1 (p < 0.001). Postoperative new onset atrial fibrillation occurred in 4 patients in Group 1 and 8 in Group 2 (p = 0.224). The duration of intensive care unit stay was 36.00 ± 22.31 h in Group 1 and 53.60 ± 59.50 h in Group 2 (p = 0.034). Development of pneumothorax, pneumonia and pleural effusion were not statistically different between the Groups (p = 0.079, 0.171, 0.509). CONCLUSION RPW application is more effective on preventing postoperative complications in cardiac surgery instead of placing drains in posterior pericardium.
Collapse
|
5
|
Mazloum SR, Gandomkar F, Tashnizi MA. The Impact of Using Ice on Quality of Pain Associated with Chest Drain Removal in Postcardiac Surgery Patients: An Evidence-Based Care. Open Nurs J 2018. [DOI: 10.2174/1874434601812010264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background:Patients undergoing cardiothoracic surgery require the placement of at least one chest drain. Chest Drain Removal (CDR) has been considered to be a painful event in patient’s postoperative recuperation.Objective:This study aimed to evaluate the impact of using ice on quality of pain associated with CDR in adult patients undergoing cardiac surgeryMaterials and Methods:This randomized, observer-blind, crossover trial was done on 51 post-cardiac surgery patients who had two chest drains in the Mashhad Heart Center in Iran. The patients were assigned to ice, placebo, and control groups. Ice and placebo bags were used over the region around the chest drains for 20 minutes prior to CDR. The quality of pain was assessedviaShort-Form McGill Pain Questionnaire (SF-MPQ) before and after CRT. The data were analyzed through the SPSS software using ANOVA, Kruskal-Wallis, and Chi-square tests.Results:The study findings revealed that the three groups were not significantly different regarding pain quality before CDR (p=0.24). However, the ice bag group (4.6±4.4) was significantly different from the placebo (8.1±6.9) and control groups (7.1±5.3) concerning the pain quality score immediately after CDR (p<0.05). The results of chi-square test also showed that the three groups were significantly different regarding “hot-burning” (p=0.009). However, no significant differences were observed with regard to other items of SF-MPQ.Conclusion:The results indicated that ice bag application could be used as an effective, safe, and inexpensive non-pharmacological intervention to reduce patients’ pain and increase their comfort during CDR.
Collapse
|
6
|
Yan S, Wang X, Lv C, Phan K, Wang Y, Wang J, Yang Y, Wu N. Mediastinal micro-vessels clipping during lymph node dissection may contribute to reduce postoperative pleural drainage. J Thorac Dis 2016; 8:415-21. [PMID: 27076936 DOI: 10.21037/jtd.2016.02.13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Postoperative pleural drainage markedly influences the length of postoperative stay and financial costs of medical care. The aim of this study is to retrospectively investigate potentially predisposing factors related to pleural drainage after curative thoracic surgery and to explore the impact of mediastinal micro-vessels clipping on pleural drainage control after lymph node dissection. METHODS From February 2012 to November 2013, 322 consecutive cases of operable non-small cell lung cancers (NSCLC) undergoing lobectomy and mediastinal lymph node dissection with or without application of clipping were collected. Total and daily postoperative pleural drainage were recorded. Propensity score matching (1:2) was applied to balance variables potentially impacting pleural drainage between group clip and group control. Analyses were performed to compare drainage volume, duration of chest tube and postoperative hospital stay between the two groups. Variables linked with pleural drainage in whole cohort were assessed using multivariable logistic regression analysis. RESULTS Propensity score matching resulted in 197 patients (matched cohort). Baseline patient characteristics were matched between two groups. Group clip showed less cumulative drainage volume (P=0.020), shorter duration of chest tube (P=0.031) and postoperative hospital stay (P=0.022) compared with group control. Risk factors significantly associated with high-output drainage in multivariable logistic regression analysis were being male, age >60 years, bilobectomy/sleeve lobectomy, pleural adhesion, the application of clip applier, duration of operation ≥220 minutes and chylothorax (P<0.05). CONCLUSIONS This study suggests that mediastinal micro-vessels clipping during lymph node dissection may reduce postoperative pleural drainage and thus shorten hospital stay.
Collapse
Affiliation(s)
- Shi Yan
- 1 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Xing Wang
- 1 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Chao Lv
- 1 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Kevin Phan
- 1 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Yuzhao Wang
- 1 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Jia Wang
- 1 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Yue Yang
- 1 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Nan Wu
- 1 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| |
Collapse
|
7
|
Mesa-Guzman M, Periklis P, Niwaz Z, Socci L, Raubenheimer H, Adams B, Gurung L, Uzzaman M, Lim E. Determining optimal fluid and air leak cut off values for chest drain management in general thoracic surgery. J Thorac Dis 2015; 7:2053-7. [PMID: 26716045 DOI: 10.3978/j.issn.2072-1439.2015.11.42] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Chest drain duration is one of the most important influencing aspects of hospital stay but the management is perhaps one of the most variable aspects of thoracic surgical care. The aim of our study is to report outcomes associated with increasing fluid and air leak criteria of protocol based management. METHODS A 6-year retrospective analysis of protocolised chest drain management starting in 2007 with a fluid criteria of 3 mL/kg increasing to 7 mL/kg in 2011 to no fluid criteria in 2012, and an air leak criteria of 24 hours without leak till 2012 when digital air leak monitoring was introduced with a criteria of <20 mL/min of air leak for more than 6 hours. Patient data were obtained from electronic hospital records and digital chest films were reviewed to determine the duration of chest tube drainage and post-drain removal complications. RESULTS From 2009 to 2012, 626 consecutive patients underwent thoracic surgery procedures under a single consultant. A total of 160 did not require a chest drain and data was missing in 22, leaving 444 for analysis. The mean age [standard deviation (SD)] was 57±19 years and 272 (61%) were men. There were no differences in the incidence of pneumothoraces (P=0.191), effusion (P=0.344) or re-interventions (P=0.431) for drain re-insertions as progressively permissive criteria were applied. The median drain duration dropped from 1-3 days (P<0.001) and accordingly hospital stay reduced from 4-6 days (P<0.001). CONCLUSIONS Our results show that chest drains can be safely removed without fluid criteria and air leak of less than 20 mL/min with median drain duration of 1 day, associated with a reduced length of hospital stay.
Collapse
Affiliation(s)
- Miguel Mesa-Guzman
- 1 Department of Thoracic Surgery, 2 Department Quality and Safety, Royal Brompton Hospital, London, UK
| | - Perikleous Periklis
- 1 Department of Thoracic Surgery, 2 Department Quality and Safety, Royal Brompton Hospital, London, UK
| | - Zakiyah Niwaz
- 1 Department of Thoracic Surgery, 2 Department Quality and Safety, Royal Brompton Hospital, London, UK
| | - Laura Socci
- 1 Department of Thoracic Surgery, 2 Department Quality and Safety, Royal Brompton Hospital, London, UK
| | - Hilgardt Raubenheimer
- 1 Department of Thoracic Surgery, 2 Department Quality and Safety, Royal Brompton Hospital, London, UK
| | - Ben Adams
- 1 Department of Thoracic Surgery, 2 Department Quality and Safety, Royal Brompton Hospital, London, UK
| | - Lokesh Gurung
- 1 Department of Thoracic Surgery, 2 Department Quality and Safety, Royal Brompton Hospital, London, UK
| | - Mohsin Uzzaman
- 1 Department of Thoracic Surgery, 2 Department Quality and Safety, Royal Brompton Hospital, London, UK
| | - Eric Lim
- 1 Department of Thoracic Surgery, 2 Department Quality and Safety, Royal Brompton Hospital, London, UK
| |
Collapse
|
8
|
Andreasen JJ, Sørensen GV, Abrahamsen ER, Hansen-Nord E, Bundgaard K, Bendtsen MD, Troelsen P. Early chest tube removal following cardiac surgery is associated with pleural and/or pericardial effusions requiring invasive treatment. Eur J Cardiothorac Surg 2015; 49:288-92. [DOI: 10.1093/ejcts/ezv005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 01/06/2015] [Indexed: 11/14/2022] Open
|
9
|
Enhanced recovery for esophagectomy: a systematic review and evidence-based guidelines. Ann Surg 2014; 259:413-31. [PMID: 24253135 DOI: 10.1097/sla.0000000000000349] [Citation(s) in RCA: 175] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This article aims to provide the first systematic review of enhanced recovery after surgery (ERAS) programs for esophagectomy and generate guidelines. BACKGROUND ERAS programs use multimodal approaches to reduce complications and accelerate recovery. Although ERAS is well established in colorectal surgery, experience after esophagectomy has been minimal. However, esophagectomy remains an extremely high-risk operation, commonly performed in patients with significant comorbidities. Consequently, ERAS may have a significant role to play in improving outcomes. No guidelines or reviews have been published in esophagectomy. METHODS We undertook a systematic review of the PubMed, EMBASE, and the Cochrane databases in July 2012. The literature was searched for descriptions of ERAS in esophagectomy. Components of successful ERAS programs were determined, and when not directly available for esophagectomy, extrapolation from related evidence was made. Graded recommendations for each component were then generated. RESULTS Six retrospective studies have assessed ERAS for esophagectomy, demonstrating favorable morbidity, mortality, and length of stay. Methodological quality is, however, low. Overall, there is little direct evidence for components of ERAS, with much derived from nonesophageal thoracoabdominal surgery. CONCLUSIONS ERAS in principle seems logical and safe for esophagectomy. However, the underlying evidence is poor and lacking. Despite this, a number of recommendations for practice and research can be made.
Collapse
|
10
|
Utter GH. The rate of pleural fluid drainage as a criterion for the timing of chest tube removal: theoretical and practical considerations. Ann Thorac Surg 2013; 96:2262-7. [PMID: 24209425 DOI: 10.1016/j.athoracsur.2013.07.055] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 07/11/2013] [Accepted: 07/16/2013] [Indexed: 11/20/2022]
Abstract
Clinicians place chest tubes approximately 1 million times each year in the United States, but little information is available to guide their management. Specifically, use of the rate of pleural fluid drainage as a criterion for tube removal is not standardized. Absent such tubes, pleural fluid drains primarily through parietal pleural lymphatics at rates approaching 500 mL of fluid per day or more for each hemithorax. Early removal of tubes does not appear to be harmful. A noninferiority randomized trial currently in progress comparing removal without considering the drainage rate to a conservative threshold (2 mL/kg body weight in 24 hours) may better inform tube management.
Collapse
Affiliation(s)
- Garth H Utter
- Department of Surgery, University of California, Davis, Medical Center, Sacramento, California.
| |
Collapse
|
11
|
Mirmohammad-Sadeghi M, Etesampour A, Gharipour M, Shariat Z, Nilforoush P, Saeidi M, Mackie M, Sadeghi FM. Early chest tube removal after coronary artery bypass graft surgery. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2012; 1:333-7. [PMID: 22666720 PMCID: PMC3364678 DOI: 10.4297/najms.2009.7333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: There is no clear data about the optimum time for chest tube removal after coronary artery bypass surgery. Aim: The aim of this study was to assess the impact of the chest tube removal time following coronary artery bypass grafting surgery on the clinical outcome of the patients. Material and Methods: An analysis of data from 307 patients was performed. The patients were randomized into two groups: in group 1 (N=107) chest tubes were removed within the first 24 hours after surgery, whereas in group 2 (N=200), chest tubes were removed in the second 24 hours after surgery. Demographics, lactate and pH at the beginning, during and after the operation, creatinine, left ventricular ejection fraction, inotropic drugs administration, length of ICU stay, and mortality data were collected. Respiratory rate and pain level was assessed. Results: In these surgeries, the mean± standard deviation for the aortic clamping time was 49.18±17.59 minutes and cardiopulmonary bypass time was 78.39±25.12 minutes. The amount of heparin consumed by the second group was higher (P <0.001) which could be considered as an important factor in increasing the drainage time after the surgery (P =0.047). The pain level evaluated 24 hours post-operation was lower in the first group, and the difference in the pain level between the 2 groups evaluated 30 hours post-operation was significant (P=0.016). The mean time of intensive care unit stay was longer in the second group but it was not statistically significant. Conclusion: Early extracting of chest tubes after coronary artery bypass graft surgery when there is no significant drainage can lead to pain reduction and consuming oxygen is an effective measure after surgery toward healing; it doesn′t increase the risk of creation of plural effusion and pericardial effusion.
Collapse
|
12
|
Fast-track rehabilitation program and conventional care after esophagectomy: a retrospective controlled cohort study. Support Care Cancer 2012; 21:707-14. [DOI: 10.1007/s00520-012-1570-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 08/13/2012] [Indexed: 12/21/2022]
|
13
|
Tabata M, Shimokawa T, Fukui T, Manabe S, Sato Y, Takanashi S. New Uncoated Vascular Prosthesis Reduces Mediastinal Tube Drainage After Thoracic Aortic Surgery. Ann Thorac Surg 2011; 91:899-902. [DOI: 10.1016/j.athoracsur.2010.11.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2010] [Revised: 11/11/2010] [Accepted: 11/15/2010] [Indexed: 10/18/2022]
|
14
|
Pre- and Postoperative Cardiopulmonary Rehabilitation in Hospitalized Patients Undergoing Coronary Artery Bypass Surgery. Am J Phys Med Rehabil 2008; 87:714-9. [DOI: 10.1097/phm.0b013e3181839152] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
15
|
Lunardi AC, Resende JM, Cerri OM, Carvalho CRFD. Efeito da continuidade da fisioterapia respiratória até a alta hospitalar na incidência de complicações pulmonares após esofagectomia por câncer. FISIOTERAPIA E PESQUISA 2008. [DOI: 10.1590/s1809-29502008000100012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O presente estudo avaliou os efeitos na incidência de complicações pulmonares do cuidado contínuo de fisioterapia respiratória no pós-operatório de esofagectomia, até a alta hospitalar. Examinaram-se retrospectivamente 40 prontuários de pacientes de esofagectomia consecutivos (nenhuma exclusão), que foram divididos em dois grupos: um dos que receberam fisioterapia respiratória apenas na unidade de tratamento intensivo (gUTI, n=20) e outro dos que a receberam até a alta hospitalar (gALTA, n=20). Foram coletadas informações referentes ao pré, intra e pós-operatório. Os resultados mostram que gUTI e gALTA, respectivamente, apresentaram-se similares (média±dp) quanto a idade (55,5±9,9 e 57,1±10,8 anos), IMC (22,5±3,3 e 18±4 kg/m²), tempo de cirurgia (400±103,8 e 408,5±142 min), tempo de anestesia (498,3±107,3 e 516±148,9 min) e número de atendimentos de fisioterapia na UTI (9,6±14,9 e 8,3±7,6). Apesar de o gALTA apresentar história de tabagismo superior (35,7±17,6 vs 26,1±18,4 maços-ano, p<0,05), houve menos 20% de complicações respiratórias após esofagectomia nesse grupo quando comparado ao gUTI (10% vs 30%, p<0,05): incidência 75% menor de derrame pleural e 50% menos broncopneumonia. Além disso, o gALTA teve permanência menor de dreno pleural no hemitórax direito (menos 4,5 dias, p<0,05). Estes achados sugerem que os cuidados de fisioterapia respiratória até a alta hospitalar podem reduzir a incidência de complicações pulmonares após esofagectomia por câncer.
Collapse
|