Subxyphoid pleural drain confers lesser impairment in respiratory muscle strength, oxygenation and lower chest pain after off-pump coronary artery bypass grafting: a randomized controlled trial.
OBJECTIVE
To evaluate respiratory muscle strength, oxygenation and chest pain in patients undergoing off-pump coronary artery bypass (OPCAB) using internal thoracic artery grafts comparing pleural drain insertion site at the subxyphoid region versus the lateral region.


METHODS
Forty patients were randomized into two groups in accordance with the pleural drain site. Group II (n = 19) -pleural drain exteriorized in the intercostal space; group (SI) (n = 21) chest tube exteriorized at the subxyphoid region. All patients underwent assessment of respiratory muscle strength (inspiratory and expiratory) on the pre, 1, 3 and 5 postoperative days (POD). Arterial blood gas analysis was collected on the pre and POD1. The chest pain sensation was measured 1, 3 and 5 POD.


RESULTS
A significant decrease in respiratory muscle strength (inspiratory and expiratory) was seen in both groups until POD5 (P <0.05). When compared, the difference between groups remained significant with greater decrease in the II (P <0.05). The blood arterial oxygenation fell in both groups (P <0.05), but the oxygenation was lower in the II (P <0.05). Referred chest pain was higher 1, 3 and 5 POD in the II group (P <0.05). The orotracheal intubation time and postoperative length of hospital stay were higher in the II group (P <0.05).


CONCLUSIONS
Patients submitted to subxyphoid pleural drainage showed less decrease in respiratory muscle strength, better preservation of blood oxygenation and reduced thoracic pain compared to patients with intercostal drain on early OPCAB postoperative.
Cardiology Discipline, São Paulo Hospital, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, SP, Brazil.
Andreia S A
AS
Cancio
Solange
S
Guizilini
Douglas W
DW
Bolzan
Renato B
RB
Dauar
José E
JE
Succi
Angelo A V
AA
de Paola
Antonio C de Camargo
AC
Carvalho
Walter J
WJ
Gomes
D002637:Chest Pain / Q000503:physiopathology*; D047549:Coronary Artery Bypass, Off-Pump; D004322:Drainage / Q000379:methods*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology*; D010100:Oxygen / Q000097:blood*; D053591:Referred Pain / Q000503:physiopathology; D010994:Pleura; D011184:Postoperative Period; D012132:Respiratory Muscles / Q000502:physiology*; D014989:Xiphoid Bone
D010100:Oxygen