title: Early Open-Lung Ventilation Improves Clinical Outcomes in Patients with Left Cardiac Dysfunction Undergoing Off-Pump Coronary Artery Bypass: a Randomized Controlled Trial.
abstract: To compare pulmonary function, functional capacity and clinical outcomes amongst three groups of patients with left ventricular dysfunction following off-pump coronary artery bypass, namely: 1) conventional mechanical ventilation (CMV); 2) late open lung strategy (L-OLS); and 3) early open lung strategy (E-OLS).
  
  
  
  Sixty-one patients were randomized into 3 groups: 1) CMV (n=21); 2) L-OLS (n=20) initiated after intensive care unit arrival; and 3) E-OLS (n=20) initiated after intubation. Spirometry was performed at bedside on preoperative and postoperative days (PODs) 1, 3, and 5. Partial pressure of arterial oxygen (PaO2) and pulmonary shunt fraction were evaluated preoperatively and on POD1. The 6-minute walk test was applied on the day before the operation and on POD5.
  
  
  
  Both the open lung groups demonstrated higher forced vital capacity and forced expiratory volume in 1 second on PODs 1, 3 and 5 when compared to the CMV group (P<0.05). The 6-minute walk test distance was more preserved, 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 and also fewer respiratory events (P<0.05). Key measures were significantly more favorable in the E-OLS group compared to the L-OLS group.
  
  
  
  Both OLSs (L-OLS and E-OLS) were able to promote higher preservation of pulmonary function, greater recovery of functional capacity and better clinical outcomes following off-pump coronary artery bypass when compared to conventional mechanical ventilation. However, in this group of patients with reduced left ventricular function, initiation of the OLS intra-operatively was found to be more beneficial and optimal when compared to OLS initiation after intensive care unit arrival.
authors.affiliation: Disciplina de Cirurgia Cardiovascular e Cardiologia da Escola Paulista de Medicina da Universidade de São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil.
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Bolzan
authors.affiliation: Disciplina de Cirurgia Cardiovascular e Cardiologia da Escola Paulista de Medicina da Universidade de São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil.
authors.forename: Walter José
authors.initials: WJ
authors.lastname: Gomes
authors.affiliation: Disciplina de Cirurgia Cardiovascular e Cardiologia da Escola Paulista de Medicina da Universidade de São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil.|Departamento de Ciência do Movimento Humana, Escola de Fisioterapia da Universidade Federal de São Paulo (UNIFESP), Santos, SP, Brazil.
authors.forename: Isadora S
authors.initials: IS
authors.lastname: Rocco
authors.affiliation: Disciplina de Cirurgia Cardiovascular e Cardiologia da Escola Paulista de Medicina da Universidade de São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil.
authors.forename: Marcela
authors.initials: M
authors.lastname: Viceconte
authors.affiliation: Disciplina de Cirurgia Cardiovascular e Cardiologia da Escola Paulista de Medicina da Universidade de São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil.
authors.forename: Mara L S
authors.initials: ML
authors.lastname: Nasrala
authors.affiliation: Disciplina de Cirurgia Cardiovascular e Cardiologia da Escola Paulista de Medicina da Universidade de São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil.
authors.forename: Hayanne O
authors.initials: HO
authors.lastname: Pauletti
authors.affiliation: Disciplina de Cirurgia Cardiovascular e Cardiologia da Escola Paulista de Medicina da Universidade de São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil.
authors.forename: Rita Simone L
authors.initials: RS
authors.lastname: Moreira
authors.affiliation: Disciplina de Cirurgia Cardiovascular e Cardiologia da Escola Paulista de Medicina da Universidade de São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil.
authors.forename: Nelson A
authors.initials: NA
authors.lastname: Hossne
authors.affiliation: Department of Physical Therapy and Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, USA.
authors.forename: Ross
authors.initials: R
authors.lastname: Arena
authors.affiliation: Disciplina de Cirurgia Cardiovascular e Cardiologia da Escola Paulista de Medicina da Universidade de São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil.|Departamento de Ciência do Movimento Humana, Escola de Fisioterapia da Universidade Federal de São Paulo (UNIFESP), Santos, SP, Brazil.
authors.forename: Solange
authors.initials: S
authors.lastname: Guizilini
mesh_terms: D047549:Coronary Artery Bypass, Off-Pump; D003324:Coronary Artery Disease / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods*; D013147:Spirometry; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000601:surgery*; D014797:Vital Capacity / Q000502:physiology*