title: Sub-xyphoid pleural drain as a determinant of functional capacity and clinical results after off-pump coronary artery bypass surgery: a randomized clinical trial.
abstract: OBJECTIVE
  The aim of this trial was to compare functional capacity, pulmonary shunt fraction and clinical outcomes between patients undergoing pleurotomy with a pleural drain inserted in the sub-xyphoid position and patients with a pleural drain placed in the intercostal position after off-pump coronary artery bypass surgery.
  
  
  METHODS
  Patients were randomized into two groups according to the pleural drain site: Group II (n = 33 intercostal pleural drain); and Group SI (n = 35 sub-xyphoid pleural drain). Functional capacity was assessed by the distance covered on the 6-min walking test performed preoperatively and on postoperative day (POD) 5; in addition, pulmonary function test was determined preoperatively and on POD 1 and 5. Pulmonary shunt fraction was evaluated preoperatively and on POD 1, and clinical outcomes were recorded throughout the study.
  
  
  RESULTS
  Group SI had better preservation of lung volumes and capacities in POD compared with Group II (P <0.05). Pulmonary shunt fraction increased in both groups postoperatively; however, Group SI showed a smaller pulmonary shunt fraction (0.26 ± 0.04 vs 0.21 ± 0.04%; P = 0.0014). Functional capacity was significantly reduced in both groups on POD 5; however, Group SI showed better preservation of functional capacity (P = 0.0001). Group SI had better postoperative clinical results, with lower incidence of atelectasis and pleural effusion (P <0.05), lower pain scores (P <0.0001), and shorter orotracheal intubation and hospitalization lengths (P <0.001).
  
  
  CONCLUSIONS
  Sub-xyphoid pleural drain determined better functional capacity and exercise tolerance with a smaller pulmonary shunt fraction and improved clinical outcomes compared with intercostal pleural drainage after off-pump coronary artery bypass surgery.
authors.affiliation: Cardiology and Cardiovascular Surgery Discipline, Federal University of São Paulo, São Paulo, Brazil Department of Human Motion Sciences, Physical Therapy School - Federal University of São Paulo, São Paulo, Brazil sguizilini@unifesp.br.
authors.forename: Solange
authors.initials: S
authors.lastname: Guizilini
authors.affiliation: Cardiology and Cardiovascular Surgery Discipline, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Alves
authors.affiliation: Cardiology and Cardiovascular Surgery Discipline, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Bolzan
authors.affiliation: Cardiology and Cardiovascular Surgery Discipline, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Andreia S A
authors.initials: AS
authors.lastname: Cancio
authors.affiliation: Cardiology and Cardiovascular Surgery Discipline, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Marisa M
authors.initials: MM
authors.lastname: Regenga
authors.affiliation: Cardiology and Cardiovascular Surgery Discipline, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Rita S L
authors.initials: RS
authors.lastname: Moreira
authors.affiliation: Cardiopulmonary Physiotherapy Laboratory, Nucleus of Research in Physical Exercise, Federal University of São Carlos, São Paulo, Brazil.
authors.forename: Renata
authors.initials: R
authors.lastname: Trimer
authors.affiliation: Cardiology and Cardiovascular Surgery Discipline, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Gomes
mesh_terms: D000368:Aged; D001938:Brazil; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000601:surgery*; D004322:Drainage / Q000009:adverse effects / Q000379:methods*; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010994:Pleura; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012129:Respiratory Function Tests; D013997:Time Factors; D016896:Treatment Outcome; D014797:Vital Capacity; D016138:Walking
keywords: Coronary artery bypass grafts; Functional capacity; Pleurotomy; Rehabilitation