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Fang HY, Chang KW, Chao YK. Ultrasound-Guided Pleural Effusion Drainage: Effect on Oxygenation, Respiratory Mechanics, and Liberation from Mechanical Ventilation in Surgical Intensive Care Unit Patients. Diagnostics (Basel) 2021; 11:diagnostics11112000. [PMID: 34829347 PMCID: PMC8625965 DOI: 10.3390/diagnostics11112000] [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: 10/12/2021] [Revised: 10/21/2021] [Accepted: 10/24/2021] [Indexed: 11/16/2022] Open
Abstract
The question as to whether an aggressive management of post-operative pleural effusion may improve clinical outcomes after major surgery remains unanswered. The aim of this study was to investigate the effect of ultrasound-guided pleural effusion drainage on oxygenation, respiratory mechanics, and liberation from mechanical ventilation in surgical intensive care unit patients. Oxygenation and respiratory mechanics were measured before and after drainage. Over an 18-month period, a total of 62 patients were analyzed. The mean drainage volume during the first 24 h was 864 ± 493 mL, and there were no procedural complications. Both the mean PaO2/FiO2 ratio and lung compliance improved after drainage. Additionally, 41.9% (n = 26) of patients were ventilator-free within 72 h after drainage. Multivariable logistic regression analysis revealed that non-cardiovascular or thoracic surgery (odds ratio [OR] = 4.968, p = 0.046), a longer time interval from operation to the onset of pleural effusion (OR = 1.165, p = 0.005), and a higher peak airway pressure (OR = 1.303, p = 0.009) were independent adverse predictors for being free from mechanical ventilation within 72 h after drainage. Specifically, patients with a time from surgery to the onset of pleural effusion ≤6 days-but not those with an interval >6 days-showed a significant post-procedural improvement in terms of PaO2/FiO2 ratio, PaCO2, peak airway pressure, and dynamic lung compliance. In summary, ultrasound-guided pleural effusion drainage resulted in significant clinical benefits in mechanically ventilated ICU patients after major surgery-especially in those with early-onset effusion who received thoracic surgery.
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Affiliation(s)
- Hsin-Yueh Fang
- Division of Thoracic Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan;
| | - Ko-Wei Chang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan;
| | - Yin-Kai Chao
- Division of Thoracic Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan;
- Correspondence:
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Jia Y, Leung SM, Turan A, Artis AS, Marciniak D, Mick S, Devarajan J, Duncan AE. Low Tidal Volumes Are Associated With Slightly Improved Oxygenation in Patients Having Cardiac Surgery. Anesth Analg 2020; 130:1396-1406. [DOI: 10.1213/ane.0000000000004608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Bolukçu A, İlhan S, Topçu AC, Günay R, Kayacıoğlu İ. Causes of Dyspnea after Cardiac Surgery. Turk Thorac J 2018; 19:165-169. [PMID: 30322444 DOI: 10.5152/turkthoracj.2018.17084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 02/19/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Postoperative dyspnea is common after cardiac surgery, even in low-risk patients. Cardiac surgeons and anesthesiologists are familiar with patients suffering from dyspnea in the early postoperative period, but in some cases, conventional treatment strategies may be ineffective, and a consultation with a pulmonologist may be required. The aim of this study is to investigate the causes of dyspnea after cardiac surgery in this particular patient group. MATERIALS AND METHODS The hospital database was searched for non-emergency cardiac surgery for the period January 2014-October 2015. Individuals with an impaired spirometry result and a history of any pulmonic disease were excluded. Only patients for whom a pulmonary consultation was needed because of dyspnea in the postoperative course were enrolled in the study. Causes of dyspnea were analyzed according to consultation reports and computed tomography findings. RESULTS One hundred and three patients were enrolled in the study. Of those, 67 (65%) were male, and the mean age was 61.50±9.43. The most common procedure was the coronary artery bypass grafting. Atelectasis (n=57, 42%) was the most common cause of dyspnea. The length of the intensive care unit (ICU) stay was significantly longer in the pneumonia group (p=0.012). Hospital mortality in the pneumonia group was significantly higher compared with other subgroups (p<0.001). CONCLUSION After cardiac surgery, atelectasis was the most common cause of dyspnea, followed by pleural effusion and pneumonia. Patients who experienced dyspnea due to pneumonia had a longer ICU stay. Developing the treatment strategies with consideration of these causes may help reduce the length of stay, morbidity, and mortality in this patient group.
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Affiliation(s)
- Ahmet Bolukçu
- Clinic of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Sami İlhan
- Clinic of Pulmonology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Ahmet Can Topçu
- Clinic of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Rafet Günay
- Clinic of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - İlyas Kayacıoğlu
- Clinic of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
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Abstract
Over the past two decades there has been a steady evolution in the practice of adult cardiac surgery with the introduction of “off-pump” surgery. However, respiratory complications remain a leading cause of postcardiac surgical morbidity and can prolong hospital stays and increase costs. The high incidence of pulmonary complications is in part due to the disruption of normal ventilatory function that is inherent to surgery in the thoracic region. Furthermore, patients undergoing such surgery often have underlying illnesses such as intrinsic lung disease (e.g., chronic obstructive pulmonary disease) and pulmonary dysfunction secondary to cardiac disease (e.g., congestive heart failure) that increase their susceptibility to postoperative respiratory problems. Given that many patients undergoing cardiac surgery are thus susceptiple to pulmonary complications, it is remarkable that more patients do not suffer from them during and after cardiac surgery. This is to a large degree because of advances in anesthetic, surgical and critical care that, for example, have reduced the physiological insults of surgery (e.g., better myocardial preservation techniques) and streamlined care in the immediate postoperative period (e.g., early extubation). Moreover, the development of minimally invasive surgery and nonbypass techniques are further evidence of the attempts at reducing the homeostatic disruptions of cardiac surgery. This review examines the available information on the incidences, consequences, and treatments of postcardiac surgery respiratory complications.
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Affiliation(s)
- Charles Weissman
- Department of Anesthesiology and Critical Care Medicine, Hadassah-Hebrew University School of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Özülkü M, Aygün F. Effect of using pump on postoperative pleural effusion in the patients that underwent CABG. Braz J Cardiovasc Surg 2016; 30:466-73. [PMID: 27163421 PMCID: PMC4614930 DOI: 10.5935/1678-9741.20150029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 04/26/2015] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The present study investigated effect of using pump on postoperative pleural effusion in patients who underwent coronary artery bypass grafting. METHODS A total of 256 patients who underwent isolated coronary artery bypass grafting surgery in the Cardiovascular Surgery clinic were enrolled in the study. Jostra-Cobe (Model 043213 105, VLC 865, Sweden) heart-lung machine was used in on-pump coronary artery bypass grafting. Off-pump coronary artery bypass grafting was performed using Octopus and Starfish. Proximal anastomoses to the aorta in both on-pump and off-pump techniques were performed by side clamps. The patients were discharged from the hospital between postoperative day 6 and day 11. RESULTS The incidence of postoperative right pleural effusion and bilateral pleural effusion was found to be higher as a count in Group 1 (on-pump) as compared to Group 2 (off-pump). But the difference was not statistically significant [P>0.05 for right pleural effusion (P=0.893), P>0.05 for bilateral pleural effusion (P=0.780)]. Left pleural effusion was encountered to be lower in Group 2 (off-pump). The difference was found to be statistically significant (P<0.05, P=0.006). CONCLUSION Under the light of these results, it can be said that left pleural effusion is less prevalent in the patients that underwent off-pump coronary artery bypass grafting when compared to the patients that underwent on-pump coronary artery bypass grafting.
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Affiliation(s)
- Mehmet Özülkü
- Konya Research and Medical Center, Başkent University, Turkey
| | - Fatih Aygün
- Konya Research and Medical Center, Başkent University, Turkey
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Franco SS, Malbouisson LMS, Grinberg M, Feltrim MIZ. A propose of pulmonary dysfunction stratification after valve surgery by physiotherapeutic assistance level. Braz J Cardiovasc Surg 2016; 30:188-97. [PMID: 26107450 PMCID: PMC4462964 DOI: 10.5935/1678-9741.20150006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 01/26/2015] [Indexed: 11/20/2022] Open
Abstract
Objective a) to propose and implement an evaluation system; b) to classify the
pulmonary involvement and determine levels of physical therapy; c) to check
the progress postoperatively. Methods Patients underwent physiotherapy assessment preoperatively, postoperatively
and after 5 days of intervention. They were classified into three levels of
care: level 1 - low risk of complication; Level 2 - medium risk; Level 3 -
high risk. We used analysis of variance and Kruskal-Wallis and analysis of
variance for repeated measures or Friedman. Chi-square test or Fisher for
proportions. We considered statistical significance level
P<0.05. Results We studied 199 patients, 156 classified within level 1, 32 at level 2 and 11
at level 3. Thoracoabdominal motion and auscultation changed significantly
postoperatively, persisting at levels 2 and 3 (P<0.05).
Oxygenation and respiratory rate changed at levels 2 and 3 postoperatively
(P<0.05) with recovery at the end. Significant
decrease in lung volumes occurred in three levels
(P<0.05) with partial recovery at level 1, lung collapse
occurred at all levels, with recovery by 56% at level 1, 47% at level 2, 27%
at level 3. Conclusion The proposed assessment identified valve surgery patients who require
differentiated physical therapy. Level 1 patients had rapid recovery, while
the level 2 showed significant changes with functional gains at the end.
Level 3 patients, more committed and prolonged recovery, should receive
greater assistance.
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Affiliation(s)
- Satiko Shimada Franco
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Max Grinberg
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Badenes R, Lozano A, Belda FJ. Postoperative pulmonary dysfunction and mechanical ventilation in cardiac surgery. Crit Care Res Pract 2015; 2015:420513. [PMID: 25705516 PMCID: PMC4332756 DOI: 10.1155/2015/420513] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 01/15/2015] [Accepted: 01/17/2015] [Indexed: 12/19/2022] Open
Abstract
Postoperative pulmonary dysfunction (PPD) is a frequent and significant complication after cardiac surgery. It contributes to morbidity and mortality and increases hospitalization stay and its associated costs. Its pathogenesis is not clear but it seems to be related to the development of a systemic inflammatory response with a subsequent pulmonary inflammation. Many factors have been described to contribute to this inflammatory response, including surgical procedure with sternotomy incision, effects of general anesthesia, topical cooling, and extracorporeal circulation (ECC) and mechanical ventilation (VM). Protective ventilation strategies can reduce the incidence of atelectasis (which still remains one of the principal causes of PDD) and pulmonary infections in surgical patients. In this way, the open lung approach (OLA), a protective ventilation strategy, has demonstrated attenuating the inflammatory response and improving gas exchange parameters and postoperative pulmonary functions with a better residual functional capacity (FRC) when compared with a conventional ventilatory strategy. Additionally, maintaining low frequency ventilation during ECC was shown to decrease the incidence of PDD after cardiac surgery, preserving lung function.
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Affiliation(s)
- Rafael Badenes
- Department of Anesthesiology and Surgical Intensive Care, Hospital Clinic Universitari de Valencia, University of Valencia, 46010 Valencia, Spain
| | - Angels Lozano
- Department of Anesthesiology and Surgical Intensive Care, Hospital Clinic Universitari de Valencia, University of Valencia, 46010 Valencia, Spain
| | - F. Javier Belda
- Department of Anesthesiology and Surgical Intensive Care, Hospital Clinic Universitari de Valencia, University of Valencia, 46010 Valencia, Spain
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Lourenço IS, Franco AM, Bassetto S, Rodrigues AJ. Pressure support-ventilation versus spontaneous breathing with "T-Tube" for interrupting the ventilation after cardiac operations. Braz J Cardiovasc Surg 2014; 28:455-61. [PMID: 24598949 PMCID: PMC4389425 DOI: 10.5935/1678-9741.20130075] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 09/02/2013] [Indexed: 11/20/2022] Open
Abstract
Objective To compare pressure-support ventilation with spontaneous breathing through a
T-tube for interrupting invasive mechanical ventilation in patients undergoing
cardiac surgery with cardiopulmonary bypass. Methods Adults of both genders were randomly allocated to 30 minutes of either
pressure-support ventilation or spontaneous ventilation with "T-tube" before
extubation. Manovacuometry, ventilometry and clinical evaluation were performed
before the operation, immediately before and after extubation, 1h and 12h after
extubation. Results Twenty-eight patients were studied. There were no deaths or pulmonary
complications. The mean aortic clamping time in the pressure support ventilation
group was 62 ± 35 minutes and 68 ± 36 minutes in the T-tube group
(P=0.651). The mean cardiopulmonary bypass duration in the
pressure-support ventilation group was 89 ± 44 minutes and 82 ± 42 minutes in the
T-tube group (P=0.75). The mean Tobin index in the pressure
support ventilation group was 51 ± 25 and 64.5 ± 23 in the T-tube group
(P=0.153). The duration of intensive care unit stay for the
pressure support ventilation group was 2.1 ± 0.36 days and 2.3 ± 0.61 days in the
T-tube group (P=0.581). The atelectasis score in the T-tube group
was 0.6 ± 0.8 and 0.5 ± 0.6 (P=0.979) in the pressure support
ventilation group. The study groups did not differ significantly in
manovacuometric and ventilometric parameters and hospital evolution. Conclusion The two trial methods evaluated for interruption of mechanical ventilation did not
affect the postoperative course of patients who underwent cardiac operations with
cardiopulmonary bypass.
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Affiliation(s)
| | | | | | - Alfredo José Rodrigues
- Correspondence address: Alfredo José Rodrigues, Hospital das Clínicas
da Faculdade de Medicina de Ribeirão Preto, Departamento de Cirurgia e Anatomia. Av,
Bandeirantes, 3.900, Campus Universitário-Monte Alegre, Ribeirão Preto, SP, Brazil -
Zip code: 14048-900. E-mail:
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9
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Ozelami Vieira IBC, Vieira FF, Abrão J, Gastaldi AC. Influence of pleural drain insertion in lung function of patients undergoing coronary artery bypass grafting. Rev Bras Anestesiol 2012; 62:696-708. [PMID: 22999402 DOI: 10.1016/s0034-7094(12)70168-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Accepted: 03/08/2012] [Indexed: 11/30/2022] Open
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. PaO(2) 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.
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Atay Y, Yagdi T, Engin C, Ayik F, Oguz E, Alayunt A, Ozbaran M, Durmaz I. Effect of pleurotomy on blood loss during coronary artery bypass grafting. J Card Surg 2009; 24:122-6. [PMID: 19267819 DOI: 10.1111/j.1540-8191.2008.00715.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND We conducted a retrospective study to compare two different techniques of internal mammarian artery (IMA) preparation concerning pleurotomy upon the effects of blood loss and pulmonary functions. METHODS Between January 1998 and November 2006, 1357 consecutive patients undergoing coronary artery bypass grafting (CABG) using the left IMA, either alone or in combination with saphenous vein graft, were included in this study. The patients were divided into two groups according to the pleural opening: Group I (n = 1046) patients underwent IMA harvesting with pleurotomy and Group 2 (n = 311) patients with intact pleura. RESULTS During the study, 27 hospital deaths (1.9%) occurred. The amount of postoperative blood loss and blood transfusion requirements were significantly higher in Group 1 than in Group 2 (p = 0.029 and p = 0.0001). The mechanical ventilation stay was significantly higher in Group 1 than in Group 2 (p = 0.0001). The incidence of left pleural effusion and atelectasis was significantly higher in Group 1 than in Group 2 on day 1 and day 3 after operation. CONCLUSIONS These results demonstrate that preserving pleural integrity has beneficial effects on the postoperative blood loss. Postoperative blood loss and transfusion requirements were higher in patients with pleurotomy. Left pleural effusion, atelectasis, and mechanical ventilatory stay were significantly reduced in patients with preserved pleural integrity.
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Affiliation(s)
- Yuksel Atay
- Cardiovascular Surgery, Ege University Hospital, Izmir, Turkey
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Comportamento anti-inflamatório da IL-6 nos derrames pleurais pós-revascularização do miocárdio*. REVISTA PORTUGUESA DE PNEUMOLOGIA 2007. [DOI: 10.1016/s0873-2159(15)30352-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Oz BS, Iyem H, Akay HT, Yildirim V, Karabacak K, Bolcal C, Demirkiliç U, Tatar H. Preservation of pleural integrity during coronary artery bypass surgery affects respiratory functions and postoperative pain: a prospective study. Can Respir J 2006; 13:145-9. [PMID: 16642229 PMCID: PMC2539018 DOI: 10.1155/2006/682575] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the role of preserved pleural integrity in postoperative pain and respiratory functional status in patients undergoing coronary revascularization. METHODS Two hundred forty patients undergoing on-pump coronary artery bypass grafting between March 2004 and February 2005 were included in the present study. The patients were prospectively randomized and divided into either an opened pleura (OP) group (n=120, patients with an OP) or a closed pleura (CP) group (n=120, patients whose pleural integrity was preserved). Preoperative patient characteristics were similar. Postoperative respiratory functions were compared between the groups by chest x-rays, respiratory functional tests and arterial blood gas analyses. Postoperative pain was compared by using a multidimensional pain score. All the tests were examined by the same blinded clinician. RESULTS The mean age of the patients was 60.4+/-8.8 years. Postoperative bleeding and the duration of hospital stay were markedly higher in the OP group than in the CP group. The incidences of atelectasis and pleural effusion were also significantly higher in the OP group (P<0.01). Respiratory functions and postoperative pain scores were better in the CP group (P<0.01 and P=0.008, respectively). CONCLUSIONS Preserving pleural integrity has beneficial effects on the respiratory functions and postoperative pain after coronary revascularization. The preservation of pleural integrity results in better respiratory function, decreased hospital stay and cost, and as a consequence, a better surgical outcome.
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Affiliation(s)
- Bilgehan Savas Oz
- Department of Cardiovascular Surgery, Gulhane Military Medical Academy, Ankara, Turkey
| | - Hikmet Iyem
- Department of Cardiovascular Surgery, Gulhane Military Medical Academy, Ankara, Turkey
| | - Hakki Tankut Akay
- Department of Cardiovascular Surgery, Gulhane Military Medical Academy, Ankara, Turkey
- Correspondence: Dr Hakki Tankut Akay, PK 56, 06552, Çankaya, Ankara, Turkey. E-mail
| | - Vedat Yildirim
- Department of Anesthesia and Reanimation, Gulhane Military Medical Academy, Ankara, Turkey
| | - Kubilay Karabacak
- Department of Cardiovascular Surgery, Gulhane Military Medical Academy, Ankara, Turkey
| | - Cengiz Bolcal
- Department of Cardiovascular Surgery, Gulhane Military Medical Academy, Ankara, Turkey
| | - Ufuk Demirkiliç
- Department of Cardiovascular Surgery, Gulhane Military Medical Academy, Ankara, Turkey
| | - Harun Tatar
- Department of Cardiovascular Surgery, Gulhane Military Medical Academy, Ankara, Turkey
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Chibante AM, Vaz MAC, Suso FV. Papel das citocinas proliferativas TGF-β e VEGF no derrame pleural pós-revascularização do miocárdio. REVISTA PORTUGUESA DE PNEUMOLOGIA 2006. [DOI: 10.1016/s0873-2159(15)30445-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Heidecker J, Sahn SA. The Spectrum of Pleural Effusions After Coronary Artery Bypass Grafting Surgery. Clin Chest Med 2006; 27:267-83. [PMID: 16716818 DOI: 10.1016/j.ccm.2006.01.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Pleural effusions are common after coronary artery bypass grafting (CABG) surgery and can be categorized by time intervals: perioperative (within the first week), early (within 1 month), late (2-12 months), or persistent (after 6 months). The perioperative effusions are usually attributable to diaphragm dysfunction or internal mammary artery harvesting and are typically self-limited. Early effusions are usually attributable to postcardiac injury syndrome and may require corticosteroid treatment. Although late effusions can have multiple causes, persistent effusions are attributable to trapped lung and often require decortication. Diagnostic thoracentesis should be performed for patients with large symptomatic pleural effusions or fever after CABG surgery. The range of management includes observation, therapeutic thoracentesis, corticosteroids, or decortication depending on the cause and course of the effusion.
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Affiliation(s)
- Jay Heidecker
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA.
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