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Pongpanit K, Laosiripisan J, Songsorn P, Charususin N, Yuenyongchaiwat K. Neural respiratory drive assessment and its correlation with inspiratory muscle strength in patients undergoing open-heart surgery: A cross-sectional study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2073. [PMID: 38284467 DOI: 10.1002/pri.2073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 09/26/2023] [Accepted: 01/11/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND AND PURPOSE Pulmonary dysfunction and inspiratory muscle weakness are frequently observed after cardiac surgery. Understanding the load on and capacity of respiratory muscles can provide valuable insights into the overall respiratory mechanics and neural regulation of breathing. This study aimed to assess the extent of neural respiratory drive (NRD) and determine whether admission-to-discharge differences in NRD were associated with inspiratory muscle strength changes among patients undergoing open-heart surgery. METHODS This cross-sectional study was conducted on 45 patients scheduled for coronary artery bypass graft or heart valve surgery. NRD was measured using a surface parasternal intercostal electromyogram during resting breathing (sEMGpara tidal) and maximal inspiratory effort (sEMGpara max). Maximal inspiratory pressure (MIP) was used to determine inspiratory muscle strength. Evaluations were performed on the day of admission and discharge. RESULTS There was a significant increase in sEMGpara tidal (6.9 ± 3.6 μV, p < 0.001), sEMGpara %max (13.7 ± 11.2%, p = 0.008), and neural respiratory drive index (NRDI, the product of EMGpara %max and respiratory rate) (337.7 ± 286.8%.breaths/min, p < 0.001), while sEMGpara max (-43.6 ± 20.4 μV, p < 0.01) and MIP (-24.4 ± 10.7, p < 0.001) significantly decreased during the discharge period. Differences in sEMGpara tidal (r = -0.369, p = 0.045), sEMGpara %max (r = -0.646, p = 0.001), and NRDI (r = -0.639, p = 0.001) were significantly associated with a reduction in MIP. DISCUSSION The findings indicate that NRD increases after open-heart surgery, which corresponds to a decrease in inspiratory muscle strength.
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Affiliation(s)
- Karan Pongpanit
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathum Thani, Thailand
| | - Jitanan Laosiripisan
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathum Thani, Thailand
| | - Preeyaphorn Songsorn
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathum Thani, Thailand
- Research Unit of Physical Therapy in Respiratory and Cardiovascular Systems, Thammasat University, Pathum Thani, Thailand
| | - Noppawan Charususin
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathum Thani, Thailand
- Research Unit of Physical Therapy in Respiratory and Cardiovascular Systems, Thammasat University, Pathum Thani, Thailand
| | - Kornanong Yuenyongchaiwat
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathum Thani, Thailand
- Research Unit of Physical Therapy in Respiratory and Cardiovascular Systems, Thammasat University, Pathum Thani, Thailand
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High-Sensitivity Cardiac Troponin T in Prediction and Diagnosis of Early Postoperative Hypoxemia after Off-Pump Coronary Artery Bypass Grafting. J Cardiovasc Dev Dis 2022; 9:jcdd9120416. [PMID: 36547413 PMCID: PMC9783538 DOI: 10.3390/jcdd9120416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022] Open
Abstract
To investigate the relationship of preoperative high-sensitivity cardiac troponin T (hs-cTnT) with early postoperative hypoxemia (EPH) following off-pump coronary artery bypass grafting (OPCAB). Records of patients undergoing OPCAB between 2018 and 2022 were reviewed. Baseline characteristics and postoperative arterial blood gas analysis were derived from the cardiovascular surgery electronic medical records. Preoperative hs-cTnT levels were measured routinely in all patients. Logistic regression analyses were performed to test the association of preoperative hs-cTnT with EPH. A total of 318 OPCAB patients were included, who had a preoperative hs-cTnT test available for review. Before surgery, 198 patients (62%) had a rise in hs-cTnT level (≥14 ng/L) and 127 patients (40%) had a more severe hs-cTnT level (≥25 ng/L). The preoperative hs-cTnT level was associated with EPH (odds ratio per ng/L, 1.86; 95% confidence interval 1.30−2.68; p < 0.001), prolonged intensive care unit stay (odds ratio, 1.58; 95% confidence interval 1.08−2.32; p = 0.019), and delayed extubating time (odds ratio, 1.63; 95% confidence interval 1.15−2.34; p = 0.007). On multivariable analysis, adjusted for BMI, hypertension, smoking status, serum creatinine, and cardiac function, preoperative hs-cTnT remained an independent factor associated with EPH. Elevation of hs-cTnT concentrations are significantly associated with EPH after OPCAB. Review of presurgical hs-cTnT concentration may help identify patients who would benefit from OPCAB to improve surgical risk assessment.
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Ahmed SS, Yousuf MS, Samad K, Ullah H, Siddiqui KM. Factors influencing the use of postoperative bilevel positive airway pressure (BiPAP) in patients undergoing adult cardiac surgery: A retrospective cohort study. Health Sci Rep 2022; 5:e873. [PMID: 36210872 PMCID: PMC9528758 DOI: 10.1002/hsr2.873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 11/06/2022] Open
Abstract
BAckground and Aims Respiratory complications are one of the biggest challenges following cardiac surgery, which can lead to hypoxia and acute respiratory failure (ARF). The aim of this study to identify the factors led to BiPAP application for postoperative respiratory complications and its effectiveness as the main outcome measures after cardiac surgery. Methods It was a retrospective cohort study with consecutive sampling technique. A total of 335 postcardiac surgery patients medical record was reviewed who were underwent for surgery from November 1, 2018 to November 30, 2019. 265 patients were finalized for the recruitment, five patients were excluded before the final analysis. Data of 260 patients were analyzed for compiling of results. Results The mean age was 59 years. 196 (75.4%) patients were males and females were 64 (24.6%). Mean weight was 72 kg and mean body mass index (BMI) 26.67 kg/m2. BiPAP application was in 38 (14.6%) patients and significantly high in with high BMI, (p < 0.05). There are significant associations of BiPAP application patients with COPD (p < 0.05). Patients with positive fluid balance, cardiac dysfunction, and required inotropic support were significantly associated with BiPAP need (p < 0.05), respectively. Conclusion BiPAP is effective to treat ARF and other respiratory complications after adult cardiac surgeries. High BMI, atelectasis, and pneumonia are also the independent factors causing ARF. BiPAP can be a successful tool for preventing the adverse effects of postoperative pulmonary complications after cardiac surgery.
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Affiliation(s)
- Syed S. Ahmed
- Department of AnaesthesiologyAga Khan UniversityKarachiPakistan
| | | | - Khalid Samad
- Department of AnaesthesiologyAga Khan UniversityKarachiPakistan
| | - Hameed Ullah
- Department of AnaesthesiologyAga Khan UniversityKarachiPakistan
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Perchermeier S, Tassani-Prell P. The Use of Corticosteroids for Cardiopulmonary Bypass in Adults. CURRENT ANESTHESIOLOGY REPORTS 2021. [DOI: 10.1007/s40140-021-00468-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Abstract
Purpose of Review
Cardiopulmonary bypass for on-pump cardiac surgery induces a systemic inflammation that may contribute to postoperative major complications. To reduce this inflammatory response in patients undergoing heart surgery, the perioperative use of anti-inflammatory corticosteroids has long been recommended to improve clinical outcomes. However, the efficacy and safety of steroids remain still unclear.
Recent Findings
We reviewed recent published literature, including the large clinical trials DECS and SIRS and the two meta-analysis by Dvirnik et al. (2018) and Ng et al. (2020), on mortality and major postoperative complications, such as myocardial complications, atrial fibrillation, stroke, pulmonary adverse events, length of ICU and hospital stay, renal failure, and infection.
Summary
The perioperative application of corticosteroids did not improve mortality rates beyond standard care or other secondary outcomes, such as myocardial infarction, stroke, renal failure, and infection. The observed increased risk of myocardial damage in patients receiving corticosteroids in the SIRS trial is mainly related to the author-defined CK-MB threshold as indicator for early myocardial injury. Interestingly, the use of steroids may have some beneficial effects on secondary outcomes: they significantly decreased the risk of respiratory failure and pneumonia and shortened the length of ICU and hospital stay, but the mechanism involved in pulmonary injury is multifactorial and it is difficult to evaluate this result. Patients receiving steroids did not have a decreased incidence of atrial fibrillation shown by the two large trials unlike some previous small sample size trials have demonstrated.
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Ge H, Lin L, Xu Y, Xu P, Duan K, Pan Q, Ying K. Airway Pressure Release Ventilation Mode Improves Circulatory and Respiratory Function in Patients After Cardiopulmonary Bypass, a Randomized Trial. Front Physiol 2021; 12:684927. [PMID: 34149459 PMCID: PMC8209333 DOI: 10.3389/fphys.2021.684927] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/10/2021] [Indexed: 11/17/2022] Open
Abstract
Importance Postoperative pulmonary complications and cardiovascular complications are major causes of morbidity, mortality, and resource utilization in cardiac surgery patients. Objectives To investigate the effects of airway pressure release ventilation (APRV) on respiration and hemodynamics in post cardiac surgery patients. Main Outcomes and Measures A single-center randomized control trial was performed. In total, 138 patients undergoing cardiopulmonary bypass were prospectively screened. Ultimately 39 patients met the inclusion criteria and were randomized into two groups: 19 patients were managed with pressure control ventilation (PCV) and 20 patients were managed with APRV. Respiratory mechanics after 4 h, hemodynamics within the first day, and Chest radiograph score (CRS) and blood gasses within the first three days were recorded and compared. Results A higher cardiac index (3.1 ± 0.7 vs. 2.8 ± 0.8 L⋅min–1⋅m2; p < 0.05), and shock volume index (35.4 ± 9.2 vs. 33.1 ± 9.7 ml m–2; p < 0.05) were also observed in the APRV group after 4 h as well as within the first day (p < 0.05). Compared to the PCV group, the PaO2/FiO2 was significantly higher after 4 h in patients of APRV group (340 ± 97 vs. 301 ± 82, p < 0.05) and within the first three days (p < 0.05) in the APRV group. CRS revealed less overall lung injury in the APRV group (p < 0.001). The duration of mechanical ventilation and ICU length of stay were not significantly (p = 0.248 and 0.424, respectively). Conclusions and Relevance Compared to PCV, APRV may be associated with increased cardiac output improved oxygenation, and decreased lung injury in postoperative cardiac surgery patients.
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Affiliation(s)
- Huiqing Ge
- Department of Respiratory Care, Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ling Lin
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ying Xu
- Department of Respiratory Care, Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Peifeng Xu
- Department of Respiratory Care, Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Kailiang Duan
- Department of Respiratory Care, Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qing Pan
- College of Information Engineering, Zhejiang University of Technology, Hangzhou, China
| | - Kejing Ying
- Department of Respiratory and Critical Care, Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Miura MC, Ribeiro de Carvalho CR, Yamada da Silveira LT, de Moraes Regenga M, Petri Damiani L, Fu C. The effects of recruitment maneuver during noninvasive ventilation after coronary bypass grafting: A randomized trial. J Thorac Cardiovasc Surg 2018; 156:2170-2177.e1. [DOI: 10.1016/j.jtcvs.2018.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 04/23/2018] [Accepted: 05/14/2018] [Indexed: 12/16/2022]
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Rodriguez-Blanco YF, Gologorsky A, Salerno TA, Lo K, Gologorsky E. Pulmonary Perfusion and Ventilation during Cardiopulmonary Bypass Are Not Associated with Improved Postoperative Outcomes after Cardiac Surgery. Front Cardiovasc Med 2016; 3:47. [PMID: 27965964 PMCID: PMC5124755 DOI: 10.3389/fcvm.2016.00047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 11/17/2016] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Clinical trials of either pulmonary perfusion or ventilation during cardiopulmonary bypass (CBP) are equivocal. We hypothesized that to achieve significant improvement in outcomes both interventions had to be concurrent. DESIGN Retrospective case-control study. SETTINGS Major academic tertiary referral medical center. PARTICIPANTS Two hundred seventy-four consecutive patients who underwent open heart surgery with CBP 2009-2013. INTERVENTIONS The outcomes of 86 patients who received pulmonary perfusion and ventilation during CBP were retrospectively compared to the control group of 188 patients. MEASUREMENTS AND MAIN RESULTS Respiratory complications rates were similar in both groups (33.7 vs. 33.5%), as were the rates of postoperative pneumonia (4.7 vs. 4.3%), pleural effusions (13.9 vs. 12.2%), and re-intubations (9.3 vs. 9.1%). Rates of adverse postoperative cardiac events including ventricular tachycardia (9.3 vs. 8.5%) and atrial fibrillation (33.7 vs. 28.2%) were equivalent in both groups. Incidence of sepsis (8.1 vs. 5.3%), postoperative stroke (2.3 vs. 2.1%), acute kidney injury (2.3 vs. 3.7%), and renal failure (5.8 vs. 3.7%) was likewise comparable. Despite similar transfusion requirements, coagulopathy (12.8 vs. 5.3%, p = 0.031) and the need for mediastinal re-exploration (17.4 vs. 9.6%, p = 0.0633) were observed more frequently in the pulmonary perfusion and ventilation group, but the difference did not reach the statistical significance. Intensive care unit (ICU) and hospital stays, and the ICU readmission rates (7.0 vs. 8.0%) were similar in both groups. CONCLUSION Simultaneous pulmonary perfusion and ventilation during CBP were not associated with improved clinical outcomes.
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Affiliation(s)
| | | | - Tomas Antonio Salerno
- Cardiovascular Surgery, University of Miami Miller School of Medicine , Miami, FL , USA
| | - Kaming Lo
- Division of Biostatistics, Department of Public Health Sciences, University of Miami , Miami, FL , USA
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Polastri M, Martin-Suarez S, Alfonsi J, Savini C. Intermittent positive pressure breathing in the cardiac surgery setting: A review. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2016. [DOI: 10.12968/ijtr.2016.23.12.567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose: To review the role of intermittent positive pressure breathing in the cardiac surgery setting. Methods: This review was conducted by searching seven major databases. A search string was built using the key words ‘intermittent positive pressure breathing’, and ‘cardiac surgery’ matched with the Boolean operator AND. Filters were selected for the publication dates January 2006 to January 2016. In each database, the search was conducted in the fields of the article title, abstract and keywords. Results: In total, seven citations that fulfilled the inclusion criteria were included in the final review. There was consensus among the authors regarding the inspiratory pressure values at which intermittent positive pressure breathing should be administered (15–30 cm H2O). The duration of treatment ranged between 15–30 minutes divided into one to three daily sessions, or was carried out considering the number of respirations. With regard to the treatment of pulmonary atelectasis, intermittent positive pressure breathing was shown to be effective after coronary artery bypass grafting, and it was the most cited postoperative intervention used to treat either pulmonary atelectasis and oxygen impairment, in cardiac surgery patients. Conclusions: The findings of this review seem to confirm that intermittent positive pressure breathing is still currently being used postoperatively in the cardiac surgery setting to treat surgery-related pulmonary complications.
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Affiliation(s)
- Massimiliano Polastri
- Physiotherapist, Physical Medicine and Rehabilitation, University Hospital Saint Orsola-Malpighi, Bologna, Italy
| | - Sofia Martin-Suarez
- Cardiac surgeon, Department of Cardiac-Thoracic and Vascular Diseases, Cardiac Surgery, University Hospital Saint Orsola-Malpighi, Bologna, Italy
| | - Jacopo Alfonsi
- Cardiac surgeon, Department of Cardiac-Thoracic and Vascular Diseases, Cardiac Surgery, University Hospital Saint Orsola-Malpighi, Bologna, Italy
| | - Carlo Savini
- Cardiac surgeon, Department of Cardiac-Thoracic and Vascular Diseases, Cardiac Surgery, University Hospital Saint Orsola-Malpighi, Bologna, Italy
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