title: Pleural subxyphoid drain confers better pulmonary function and clinical outcomes in chronic obstructive pulmonary disease after off-pump coronary artery bypass grafting: a randomized controlled trial.
abstract: OBJECTIVE
  To evaluate the lung function and clinical outcome in severe chronic obstructive pulmonary disease in patients undergoing off-pump coronary artery bypass grafting with left internal thoracic artery graft, comparing the pleural drain insertion in the intercostal versus subxyphoid region.
  
  
  METHODS
  A randomized controlled trial. Chronic obstructive pulmonary disease patients were randomized into two groups according pleural drain site: II group (n=27) - pleural drain in intercostal space; SI group (n=29) - pleural drain in the subxyphoid region. Spirometry values (Forced Vital Capacity - and Forced expiratory volume in 1 second) were obtained on preoperative and 1, 3 and 5 postoperative days. Chest x-ray from preoperative until postoperative day 5 (POD5) was performed for monitoring respiratory events, such as atelectasis and pleural effusion. Pulmonary shunt fraction and pain score was evaluate preoperatively and on postoperative day 1.
  
  
  RESULTS
  In both groups there was a significant decrease of the spirometry values (Forced Vital Capacity and Forced expiratory volume in 1 second) until POD5 (P<0.05). However, when compared, SI group presented less decrease in these parameters (P<0.05). Pulmonary shunt fraction was significantly lower in SI group (P<0.05). Respiratory events, pain score, orotracheal intubation time and postoperative length of hospital stay were lower in the SI group (P<0.05).
  
  
  CONCLUSIONS
  Subxyphoid pleural drainage in severe Chronic obstructive pulmonary disease patients determined better preservation and recovery of pulmonary capacity and volumes with lower pulmonary shunt fraction and better clinical outcomes on early postoperative off-pump coronary artery bypass grafting.
authors.affiliation: São Paulo Hospital, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Solange
authors.initials: S
authors.lastname: Guizilini
authors.affiliation: São Paulo Hospital, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Marcela
authors.initials: M
authors.lastname: Viceconte
authors.affiliation: São Paulo Hospital, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Gabriel Tavares da M
authors.initials: GT
authors.lastname: Esperança
authors.affiliation: São Paulo Hospital, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Bolzan
authors.affiliation: São Paulo Hospital, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Milena
authors.initials: M
authors.lastname: Vidotto
authors.affiliation: São Paulo Hospital, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Rita Simone L
authors.initials: RS
authors.lastname: Moreira
authors.affiliation: São Paulo Hospital, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Andréia Azevedo
authors.initials: AA
authors.lastname: Câncio
authors.affiliation: São Paulo Hospital, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Gomes
mesh_terms: D000328:Adult; D000368:Aged; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000379:methods*; D004322:Drainage / Q000379:methods*; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007902:Length of Stay; D008168:Lung / Q000502:physiology*; D008297:Male; D008323:Mammary Arteries / Q000601:surgery*; D008875:Middle Aged; D010994:Pleura; D010996:Pleural Effusion / Q000517:prevention & control; D011183:Postoperative Complications / Q000534:rehabilitation; D011184:Postoperative Period; D001261:Pulmonary Atelectasis / Q000517:prevention & control; D029424:Pulmonary Disease, Chronic Obstructive / Q000209:etiology / Q000534:rehabilitation*; D013147:Spirometry; D018709:Statistics, Nonparametric; D013997:Time Factors; D014797:Vital Capacity