scholarly journals The effects of mechanical insufflation-exsufflation on lung function and complications in cardiac surgery patients: a pilot study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Meng-Fang Wu ◽  
Tsai-Yu Wang ◽  
Da-Shen Chen ◽  
Hsiu-Fong Hsiao ◽  
Han-Chuang Hu ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Chest Pain ◽  
Lung Function ◽  
Clinical Outcomes ◽  
Tertiary Hospital ◽  
Forced Expiratory Volume ◽  
Pulmonary Complications ◽  
Positive Pressure ◽  
Lung Expansion ◽  
Intermittent Positive Pressure Breathing

Abstract Background Postoperative positive pressure lung expansion is associated with decreased pulmonary complications and improved clinical outcomes. The aim of the present study was to compare the differences in post-operative pulmonary complications and clinical outcomes between two groups of study subjects who underwent cardiac surgery; one included subjects who received mechanical insufflation-exsufflation (MI-E) and the other included subjects who received intermittent positive pressure breathing (IPPB) therapy. Methods This retrospective study included 51 subjects, who underwent cardiac surgery in an intensive care unit of a tertiary hospital during the time period from June 2017 to February 2018. After liberation from mechanical ventilation, the subjects received lung expansion therapy by means of two types of positive pressure devices, MI-E (n = 21) or IPPB (n = 30). The pulmonary complications, lung function, and clinical outcomes were compared between the two groups. Results Subjects in both groups displayed similar baseline characteristics and underwent similar types of surgical procedures. Compared to subjects who received non-oscillatory therapy, those who received MI-E therapy had higher post-operative force vital capacity (58.4 ± 4.74% vs. 46.0 ± 3.70%, p = 0.042), forced expiratory volume in one second (62.4 ± 5.23% vs. 46.8 ± 3.83%, p = 0.017), and peak flow rate (67.1 ± 5.53 L vs. 55.7 ± 4.44 L p = 0.111). However, the incidence of chest pain was higher in the MI-E group (n = 13, 61.9%) than in the IPPB group (n = 4, 16.7%; odds ratio, 0.123, 95% confidence interval, 0.03–0.45; p = 0.002). The length of hospital and ICU stay, development of atelectasis, pneumonia, and pleural effusion were similar in both the groups. Conclusion Both IPPB and MI-E therapies have similar effects on preventing post-operative complications in cardiac surgery patients. However, compared to IPPB therapy, MI-E therapy was associated with better-preserved pulmonary function and higher incidence of chest pain.

The Effects of Mechanical Insufflation-Exsufflation on Lung Function and Complications in Cardiac Surgery Patients

2020 ◽  
Author(s):  
Meng-Fang Wu ◽  
Tsai-Yu Wang ◽  
Da-Shen Chen ◽  
Shou-Fong Shiao ◽  
Han-Chuang Hu ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Chest Pain ◽  
Lung Function ◽  
Clinical Outcomes ◽  
Tertiary Hospital ◽  
Forced Expiratory Volume ◽  
Pulmonary Complications ◽  
Positive Pressure ◽  
Lung Expansion ◽  
Intermittent Positive Pressure Breathing

Abstract Background: Postoperative positive pressure lung expansion is associated with decreased pulmonary complications and improved clinical outcomes. The aim of the present study was to compare the differences in post-operative pulmonary complications and clinical outcomes between two groups of study subjects who underwent cardiac surgery; one included subjects who received mechanical insufflation-exsufflation (MI-E) and the other included subjects who received intermittent positive pressure breathing (IPPB) therapy.Methods: This retrospective study included 48 subjects, who underwent cardiac surgery in an intensive care unit of a tertiary hospital during the time period from June 2017 to February 2018. After liberation from mechanical ventilation, the subjects received lung expansion therapy by means of two type of positive pressure devices, MI-E (n=20) or IPPB (n=28). The pulmonary complications, lung function, and clinical outcomes were compared between the two groups.Results: Subjects in both groups displayed similar baseline characteristics and underwent similar types of surgical procedures. Compared to subjects who received non-oscillatory therapy, those who received MI-E therapy had higher post-operative force vital capacity (58.9±4.96 % vs. 45.21±3.60 %, p=0.026), forced expiratory volume in one second (63.35±5.4 % vs. 45.48±3.63 %, p=0.007), and peak flow rate (68.5±5.53 % vs. 54.75±4.11 %, p=0.047). However, the incidence of chest pain was higher in the MI-E group (n=13, 65%) than in the IPPB group (n=4, 14.3%; odds ratio, 11.14, 95% confidence interval, 2.74-45.26; p=0.001). The length of hospital and ICU stay, development of atelectasis, pneumonia, and pleural effusion were similar in both the groups.Conclusion: Both IPPB and MI-E therapies have similar effects on preventing post-operative complications in cardiac surgery patients. However, compared to IPPB therapy, MI-E therapy was associated with improved pulmonary function and higher incidence of chest pain.

scholarly journals The Effects of Mechanical Insufflation-Exsufflation on Lung Function and Complications in Cardiac Surgery Patients: A Pilot Study

2020 ◽  
Author(s):  
Meng-Fang Wu ◽  
Tsai-Yu Wang ◽  
Da-Shen Chen ◽  
Hsiu-Fong Hsiao ◽  
Han-Chuang Hu ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Chest Pain ◽  
Lung Function ◽  
Clinical Outcomes ◽  
Tertiary Hospital ◽  
Forced Expiratory Volume ◽  
Pulmonary Complications ◽  
Positive Pressure ◽  
Lung Expansion ◽  
Intermittent Positive Pressure Breathing

Abstract Background: Postoperative positive pressure lung expansion is associated with decreased pulmonary complications and improved clinical outcomes. The aim of the present study was to compare the differences in post-operative pulmonary complications and clinical outcomes between two groups of study subjects who underwent cardiac surgery; one included subjects who received mechanical insufflation-exsufflation (MI-E) and the other included subjects who received intermittent positive pressure breathing (IPPB) therapy. Methods: This retrospective study included 51 subjects, who underwent cardiac surgery in an intensive care unit of a tertiary hospital during the time period from June 2017 to February 2018. After liberation from mechanical ventilation, the subjects received lung expansion therapy by means of two types of positive pressure devices, MI-E (n=21) or IPPB (n=30). The pulmonary complications, lung function, and clinical outcomes were compared between the two groups. Results: Subjects in both groups displayed similar baseline characteristics and underwent similar types of surgical procedures. Compared to subjects who received non-oscillatory therapy, those who received MI-E therapy had higher post-operative force vital capacity (58.4±4.74 % vs. 46.0±3.70 %, p=0.042), forced expiratory volume in one second (62.4±5.23 % vs. 46.8±3.83 %, p=0.017), and peak flow rate (67.1±5.53 L vs. 55.7±4.44 L p=0.111). However, the incidence of chest pain was higher in the MI-E group (n=13, 61.9%) than in the IPPB group (n=4, 16.7%; odds ratio, 0.123, 95% confidence interval, 0.03-0.45; p=0.002). The length of hospital and ICU stay, development of atelectasis, pneumonia, and pleural effusion were similar in both the groups. Conclusion : Both IPPB and MI-E therapies have similar effects on preventing post-operative complications in cardiac surgery patients. However, compared to IPPB therapy, MI-E therapy was associated with better-preserved pulmonary function and higher incidence of chest pain.

Assessment of factors affecting short-term pulmonary functions following cardiac surgery: A prospective observational study

2021 ◽  
pp. 021849232110100
Author(s):  
Neetika Katiyar ◽  
Sandeep Negi ◽  
Sunder Lal Negi ◽  
Goverdhan Dutt Puri ◽  
Shyam Kumar Singh Thingnam
Keyword(s):  
Cardiac Surgery ◽  
Pulmonary Function ◽  
Forced Vital Capacity ◽  
Vital Capacity ◽  
Forced Expiratory Volume ◽  
Pulmonary Complications ◽  
Operative Morbidity ◽  
Factors Affecting ◽  
Factors Influencing ◽  
Significant Impairment

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.

Intermittent positive pressure breathing in the cardiac surgery setting: A review

2016 ◽  
Vol 23 (12) ◽  
pp. 567-573
Author(s):  
Massimiliano Polastri ◽  
Sofia Martin-Suarez ◽  
Jacopo Alfonsi ◽  
Carlo Savini
Keyword(s):  
Cardiac Surgery ◽  
Positive Pressure ◽  
Intermittent Positive Pressure Breathing

scholarly journals Perioperative Pulmonary Atelectasis: Part II. Clinical Implications

2021 ◽  
Author(s):  
David Lagier ◽  
Congli Zeng ◽  
Ana Fernandez-Bustamante ◽  
Marcos F. Vidal Melo
Keyword(s):  
Ventilatory Support ◽  
Pulmonary Complications ◽  
Anesthetic Technique ◽  
Positive Pressure ◽  
Surgical Patient ◽  
Lung Collapse ◽  
Impedance Tomography ◽  
Pulmonary Atelectasis ◽  
Lung Expansion ◽  
Bedside Diagnosis

The development of pulmonary atelectasis is common in the surgical patient. Pulmonary atelectasis can cause various degrees of gas exchange and respiratory mechanics impairment during and after surgery. In its most serious presentations, lung collapse could contribute to postoperative respiratory insufficiency, pneumonia, and worse overall clinical outcomes. A specific risk assessment is critical to allow clinicians to optimally choose the anesthetic technique, prepare appropriate monitoring, adapt the perioperative plan, and ensure the patient’s safety. Bedside diagnosis and management have benefited from recent imaging advancements such as lung ultrasound and electrical impedance tomography, and monitoring such as esophageal manometry. Therapeutic management includes a broad range of interventions aimed at promoting lung recruitment. During general anesthesia, these strategies have consistently demonstrated their effectiveness in improving intraoperative oxygenation and respiratory compliance. Yet these same intraoperative strategies may fail to affect additional postoperative pulmonary outcomes. Specific attention to the postoperative period may be key for such outcome impact of lung expansion. Interventions such as noninvasive positive pressure ventilatory support may be beneficial in specific patients at high risk for pulmonary atelectasis (e.g., obese) or those with clinical presentations consistent with lung collapse (e.g., postoperative hypoxemia after abdominal and cardiothoracic surgeries). Preoperative interventions may open new opportunities to minimize perioperative lung collapse and prevent pulmonary complications. Knowledge of pathophysiologic mechanisms of atelectasis and their consequences in the healthy and diseased lung should provide the basis for current practice and help to stratify and match the intensity of selected interventions to clinical conditions.

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