title: Open-Lung Ventilation Improves Clinical Outcomes in Off-Pump Coronary Artery Bypass Surgery: A Randomized Controlled Trial.
abstract: OBJECTIVE
  To compare pulmonary function, functional capacity, and clinical outcomes among conventional mechanical ventilation (CMV), early open-lung (EOL), and late open-lung (LOL) strategies after off-pump coronary artery bypass surgery (OPCAB).
  
  
  METHODS
  Prospective, randomized, and double-blinded study.
  
  
  METHODS
  Two hospitals of the Federal University of Sao Paulo, Brazil.
  
  
  METHODS
  Ninety-three patients undergoing elective first-time OPCAB.
  
  
  METHODS
  Patients were randomized into 3 groups: CMV (n=31); LOL (n=32) initiated upon intensive care unit (ICU) arrival; EOL (n = 30) initiated after intubation.
  Spirometry was performed at bedside preoperatively and on postoperative days (PODs) 1, 3, and 5. Partial pressure of arterial oxygen (PaO2) and pulmonary shunt fraction were evaluated presurgically and on POD 1; 6-minute walk test (6MWT) was performed presurgically and on POD 5. Both open-lung groups demonstrated higher forced vital capacity and forced expiratory volume in 1 second on PODs 1, 3 and 5 compared to the CMV group (p<0.05). Similar results were found in relation to the 6MWT distance. Shunt fraction was lower and PaO2 was higher in both open-lung groups (p<0.05). Open-lung groups had shorter intubation time and hospital stay as well as fewer respiratory events (p<0.05). No statistical difference was found relative to the aforementioned results when the EOL and LOL groups were compared.
  
  
  CONCLUSIONS
  Both open-lung strategies were able to promote higher pulmonary function preservation and greater recovery of functional capacity with better clinical outcomes after OPCAB. No difference in outcome was found when comparing initiation of OLS intraoperatively or after ICU arrival.
authors.affiliation: Cardiovascular and Surgery Discipline, Sao Paulo Hospital, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Bolzan
authors.affiliation: Cardiopulmonary Physiotherapy Laboratory, Nucleus of Research in Physical Exercise, Federal University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Renata
authors.initials: R
authors.lastname: Trimer
authors.affiliation: Cardiovascular and Surgery Discipline, Sao Paulo Hospital, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Isis
authors.initials: I
authors.lastname: Begot
authors.affiliation: Cardiovascular and Surgery Discipline, Sao Paulo Hospital, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Mara L S
authors.initials: ML
authors.lastname: Nasrala
authors.affiliation: Cardiovascular and Surgery Discipline, Sao Paulo Hospital, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Patricia
authors.initials: P
authors.lastname: Forestieri
authors.affiliation: Cardiovascular and Surgery Discipline, Sao Paulo Hospital, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Vanessa M F
authors.initials: VM
authors.lastname: Mendez
authors.affiliation: Department of Physical Therapy and Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois, Chicago, Chicago, IL.
authors.forename: Ross
authors.initials: R
authors.lastname: Arena
authors.affiliation: Cardiovascular and Surgery Discipline, Sao Paulo Hospital, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Gomes
authors.affiliation: Cardiovascular and Surgery Discipline, Sao Paulo Hospital, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil; Department of Human Movement Sciences, Physiotherapy School, Federal University of Sao Paulo, Sao Paulo, Brazil. Electronic address: s_guizilini@yahoo.com.br.
authors.forename: Solange
authors.initials: S
authors.lastname: Guizilini
mesh_terms: D000328:Adult; D000368:Aged; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011175:Positive-Pressure Respiration; D011446:Prospective Studies; D012121:Respiration, Artificial; D014797:Vital Capacity
chemical_list: D010100:Oxygen
keywords: functional capacity; off-pump coronary artery bypass surgery; open-lung ventilation; pulmonary function