Short‐term changes in pulmonary function and respiratory movements after cardiac surgery via median sternotomy

Background Pulmonary complications after cardiac surgery are very common and lead to an increased incidence of post-operative morbidity and mortality. Several factors, either modifiable or non-modifiable, may contribute to the associated unfavorable consequences related to pulmonary function. This study was aimed to investigate the degree of alteration and factors influencing pulmonary function (forced expiratory volume in one second (FEV1) and forced vital capacity), on third, fifth, and seventh post-operative days following cardiac surgery. Methods This study was executed in 71 patients who underwent on-pump cardiac surgery. Pulmonary function was assessed before surgery and on the third, fifth, and seventh post-operative days. Data including surgical details, information about risk factors, and assessment of pulmonary function were obtained. Results The FEV1 and forced vital capacity were significantly impaired on post-operative days 3, 5, and 7 compared to pre-operative values. The reduction in FEV1 was 41%, 29%, and 16% and in forced vital capacity was 42%, 29%, and 19% consecutively on post-operative days 3, 5, and 7. Multivariate analysis was done to detect the factors influencing post-operative FEV1 and forced vital capacity. Discussion This study observed a significant impairment in FEV1 and forced vital capacity, which did not completely recover by the seventh post-operative day. Different factors affecting post-operative FEV1 and forced vital capacity were pre-operative FEV1, age ≥60, less body surface area, lower pre-operative chest expansion at the axillary level, and having more duration of cardiopulmonary bypass during surgery. Presence of these factors enhances the chance of developing post-operative pulmonary complications.

Download Full-text

Abstract 3248: Is It Safe to Train Residents to Perform Cardiac Surgery? Intermediate Term Follow-up

Circulation ◽

10.1161/circ.116.suppl_16.ii_730-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Billie Jean Martin ◽

Dimitri Kalavrouziotis ◽

Roger Baskett

Keyword(s):

Cardiac Surgery ◽

Hospital Mortality ◽

Proportional Hazards ◽

Artery Bypass ◽

Cox Proportional Hazards ◽

Adverse Outcomes ◽

Short Term ◽

Term Outcome ◽

Teaching Case ◽

Teaching Cases

Introduction While there are rigourous assessments made of trainees’ knowledge through formal examinations, objective assessments of technical skills are not available. Little is known about the safety of allowing resident trainees to perform cardiac surgical operations. Methods Peri-operative date was prospectively collected on all patients who underwent coronary artery bypass grafting (CABG), aortic valve replacement (AVR) or a combined procedure between 1998 and 2005. Teaching-cases were identified by resident records and defined as cases which the resident performed skin to skin. Pre-operative characteristics were compared between teaching and non-teaching cases. Short-term adverse events were defined as a composite of: in-hospital mortality, stroke, intra- or post-operative intra-aortic balloon pump (IABP) insertion, myocardial infarction, renal failure, wound infection, sepsis or return to the operating room. Intermediate adverse outcomes were defined as hospital readmission for any cardiac disease or late mortality. Logistic regression and Cox proportional hazard models were used to adjust for differences in age, acuity, and medical co-morbidities. Outcomes were compared between teaching and non-teaching cases. Results 6929 cases were included, 895 of which were identified as teaching-cases. Teaching-cases were more likely to have an EF<40%, pre-operative IABP, CHF, combined CABG/AVRs or total arterial grafting cases (all p<0.01). However, a case being a teaching-case was not a predictor of in-hospital mortality (OR=1.02, 95%CI 0.67–1.55) or the composite short-term outcome (OR=0.97, 95%CI 0.75–1.24). The Kaplan-Meier event-free survival of staff and teaching-cases was equivalent at 1, 3, and 5 years: 80% vs. 78%, 67% vs. 66%, and 58% vs. 55% (log-rank p=0.06). Cox proportional hazards regression modeling did not demonstrate teaching-case to be a predictor of late death or re-hospitalization (HR=1.05, 95%CI 0.94 –1.18). Conclusions Teaching-cases were more likely to have greater acuity and complexity than non-teaching cases. Despite this, teaching cases did no worse than staff cases in the short or intermediate term. Allowing residents to perform cardiac surgery does not appear to adversely affect patient outcomes.

Download Full-text

Liposomal bupivacaine infiltration after median sternotomy incision in pediatric cardiac surgery

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2021.01.053 ◽

2021 ◽

Author(s):

Christopher F. Tirotta ◽

Richard G. Lagueruela ◽

Daria Salyakina ◽

Apeksha Gupta ◽

Frank Alonso ◽

...

Keyword(s):

Cardiac Surgery ◽

Median Sternotomy ◽

Pediatric Cardiac Surgery ◽

Liposomal Bupivacaine

Download Full-text

Effect of Short-Term Exposure to Low Levels of SO2 and NO x on Pulmonary Function and Methacholine and Allergen Bronchial Sensitivities in Asthmatic Children

Archives of Environmental Health An International Journal ◽

10.1080/00039896.1991.9934390 ◽

1991 ◽

Vol 46 (5) ◽

pp. 296-299 ◽

Cited By ~ 15

Author(s):

Jing-Long Huang ◽

Shih-Yue Wang ◽

Kue-Hsiung Hsieh

Keyword(s):

Pulmonary Function ◽

Short Term ◽

Asthmatic Children ◽

Short Term Exposure ◽

Low Levels

Download Full-text

Preoperative cigarette smoking and short-term morbidity and mortality after cardiac surgery: a meta-analysis

Heart Asia ◽

10.1136/heartasia-2018-011069 ◽

2018 ◽

Vol 10 (2) ◽

pp. e011069 ◽

Cited By ~ 1

Author(s):

Nicholas Gregory Ross Bayfield ◽

Adrian Pannekoek ◽

David Hao Tian

Keyword(s):

Cardiac Surgery ◽

Smoking Status ◽

Meta Analysis ◽

Surgical Site Infections ◽

Neurological Complications ◽

Pulmonary Complications ◽

Morbidity And Mortality ◽

Surgical Patients ◽

Short Term ◽

Increased Risk

Currently, the choice of whether or not to electively operate on current smokers is varied among cardiothoracic surgeons. This meta-analysis aims to determine whether preoperative current versus ex-smoking status is related to short-term postoperative morbidity and mortality in cardiac surgical patients. Systematic literature searches of the PubMed, MEDLINE and Cochrane databases were carried out to identify all studies in cardiac surgery that investigated the relationship between smoking status and postoperative outcomes. Extracted data were analysed by random effects models. Primary outcomes included 30-day or in-hospital all-cause mortality and pulmonary morbidity. Overall, 13 relevant studies were identified, with 34 230 patients in current or ex-smoking subgroups. There was no difference in mortality (p=0.93). Current smokers had significantly higher risk of overall pulmonary complications (OR 1.44; 95% CI 1.27 to 1.64; p<0.001) and postoperative pneumonia (OR 1.62; 95% CI 1.27 to 2.06; p<0.001) as well as lower risk of postoperative renal complications (OR 0.82; 95% CI 0.70 to 0.96; p=0.01) compared with ex-smokers. There was a trend towards an increased risk of postoperative MI (OR 1.29; 95% CI 0.95 to 1.75; p=0.10). No difference in postoperative neurological complications (p=0.15), postoperative sternal surgical site infections (p=0.20) or postoperative length of intensive care unit stay (p=0.86) was seen. Cardiac surgical patients who are current smokers at the time of operation do not have an increased 30-day mortality risk compared with ex-smokers, although they are at significantly increased risk of postoperative pulmonary complications.

Download Full-text