title: Fast-track pulmonary conditioning before urgent cardiac surgery in patients with insufficiently treated chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  Chronic obstructive pulmonary disease (COPD) is an important risk factor for perioperative morbidity and mortality in patients undergoing cardiac surgery. Despite high clinical relevance, current guidelines lack clear recommendations on the optimal approach for patients with insufficiently treated COPD and urgent need for cardiac surgery. The aim of the present study was to analyze the efficacy of short-term pulmonary conditioning (PC) in this subset of cardiopulmonary patients.
  
  
  METHODS
  Eighteen patients with urgent need for cardiac surgery were treated with 1 mg budenoside twice a day, 1.25 mg salbutamol four times a day and 15 mg ambroxol three times a day. On average, patients received pulmonary conditioning for 5.1 ± 2.1 days. Lung function was assessed before and after treatment.
  
  
  RESULTS
  Pulmonary conditioning improved forced expiratory volume in one second (FEV1) by 16% (P<0.001). Predicted FEV1 increased from 48.3 ± 13.6% at baseline to 55.4 ± 16.1% after treatment (P<0.001). Total resistance was reduced from 0.933 ± 0.418 kPa·s/L to 0.631 ± 0.344 kPa·s/L after PC (P=0.004). The percentage of patients in GOLD stages III-IV was reduced from 55.6% at baseline to 27.8% after treatment. After surgery, patients needed mechanical ventilation for 2 ± 3.4 days. One patient (5.6%) received a tracheostomy and four patients (22.2%) developed pneumonia; 30-day mortality was 5.6%.
  
  
  CONCLUSIONS
  Short-term treatment with budenoside, salbutamol and ambroxol significantly improved lung function parameters. If surgery can be delayed for several days, pulmonary conditioning should be considered for patients with insufficiently treated COPD.
authors.affiliation: Department of Cardiology and Angiology, Campus Mitte, Charité - University Medicine Berlin School of Medicine, Berlin, Germany. henryk.dreger@charite.de
authors.forename: H
authors.initials: H
authors.lastname: Dreger
authors.forename: B
authors.initials: B
authors.lastname: Schaumann
authors.forename: T
authors.initials: T
authors.lastname: Gromann
authors.forename: R
authors.initials: R
authors.lastname: Hetzer
authors.forename: C
authors.initials: C
authors.lastname: Melzer
mesh_terms: D000368:Aged; D000403:Airway Resistance; D000420:Albuterol / Q000008:administration & dosage; D000551:Ambroxol / Q000008:administration & dosage; D001993:Bronchodilator Agents / Q000008:administration & dosage; D019819:Budesonide / Q000008:administration & dosage; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005100:Expectorants / Q000008:administration & dosage; D005260:Female; D005541:Forced Expiratory Volume; D005858:Germany; D006331:Heart Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008168:Lung / Q000187:drug effects* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000209:etiology; D011300:Preoperative Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D020127:Recovery of Function; D012121:Respiration, Artificial; D012129:Respiratory Function Tests; D019141:Respiratory System Agents / Q000008:administration & dosage*; D013997:Time Factors; D014139:Tracheostomy; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents; D005100:Expectorants; D019141:Respiratory System Agents; D000551:Ambroxol; D019819:Budesonide; D000420:Albuterol