The effect of postoperative positive end-expiratory pressure on postoperative bleeding after off-pump coronary artery bypass grafting.
BACKGROUND
To compare postoperative prophylactic use of two positive end-expiratory pressure (PEEP) levels in order to prevent postoperative bleeding in patients undergoing off-pump coronary artery bypass grafting (CABG) surgery.


METHODS
Sixty patients undergoing an elective off-pump CABG operation were included in this prospective, nonrandomized clinical trial. Patients were divided into two groups as receiving either 5 cm H2O (group 1) or 8 cm H2O PEEP (group 2) after the operation until being extubated. Chest tube outputs, use of blood products and other fluids, postoperative hemoglobin levels, accumulation of pleural and pericardial fluid after the removal of chest tubes, and duration of hospital stay were recorded and compared.


RESULTS
Low- and high-pressure PEEP groups did not differ with regard to postoperative chest tube outputs, amounts of transfusions and crystalloid/colloid infusion requirements, or postoperative hemoglobin levels. However, low-pressure PEEP application was associated with significantly higher pleural (92 ±37 ml vs. 69 ±29 ml, p = 0.03) and pericardial fluid (17 ±5 ml vs. 14 ±6 ml, p = 0.04) accumulation. On the other hand, high-pressure PEEP application was associated with significantly longer duration of hospitalization (6.25 ±1.21 days vs. 5.25 ±0.91 days, p = 0.03).


CONCLUSIONS
Prophylactic administration of postoperative PEEP levels of 8 cm H2O, although safe, does not seem to reduce chest-tube output or transfusion requirements in off-pump CABG when compared to the lower level of PEEP. Further studies with larger sample sizes are warranted to confirm the benefits and identify ideal levels of PEEP administration in this group of patients.
Department of Anesthesiology and Reanimation, Medicana Hospitals Camlica, Istanbul, Turkey.
Yahya
Y
Yildiz
Department of Anesthesiology and Reanimation, Medicana Hospitals Camlica, Istanbul, Turkey.
Ece
E
Salihoglu
Department of Anesthesiology and Reanimation, Medicana Hospitals Camlica, Istanbul, Turkey.
Sezai
S
Celik
Department of Cardiovascular Surgery, Duzce Ataturk State Hospital, Duzce, Turkey.
Murat
M
Ugurlucan
Department of Cardiology, Bakirkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
Ilker Murat
IM
Caglar
Department of Cardiology, Samatya State Hospital, Istanbul, Turkey.
Fatma Nihan
FN
Turhan-Caglar
Department of Anesthesiology and Reanimation, Medicana Hospitals Camlica, Istanbul, Turkey ; Department of Cardiovascular Surgery, Pendik Bolge Hospital, Istanbul, Turkey.
Omer
O
Isik
bleeding; off-pump coronary artery bypass grafting; pericardial effusion; pleural effusion; positive end-expiratory pressure