Özge Altaş1, Onur Yerlikhan1, Mehmet Aksüt1, Tanıl Özer1, Cantürk Çakalağaoğlu1, Cengiz Köksal2
1Department of Cardiovascular Surgery, University of Health Sciences, Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital, Istanbul, Turkey
2Department of Cardiovascular Surgery, Bezmialem Foundation University, Medicine Faculty Hospital, Istanbul, Turkey
Keywords: Blood gas analysis, cardiac surgical procedures, pleural effusion, respiratory insufficiency
Objectives: The aim of this study was to evaluate the effects of pleural integrity on respiratory system functions after cardiac surgery.
Patients and methods: In this prospective, cohort study, a total of 114 patients (84 males, 30 females; mean age 56.3±13.1 years; range, 21 to 76 years) who underwent on-pump cardiac surgery between February 2016 and June 2016 were included. The patients were divided into two groups: open (Group 1, n=56) and intact pleura (Group 2, n=58). Arterial blood gas values (pH, partial pressure of oxygen [PaO2], partial pressure of carbon dioxide [PaCO2], and oxygen saturation [SaO2]), and respiratory and heart rates were evaluated per-operatively. Preoperative and the fifth postoperative day values of forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC% were compared between the groups.
Results: Extubation time and duration of mechanical ventilation were similar in both groups (p>0.05). There was a significant decrease of FEV1 and FVC of open versus intact pleura group in terms of preoperative and the fifth postoperative day values (p<0.001 and p<0.001, respectively). There was no significant difference in the PaCO2 in arterial blood gas between the groups (open; 38.6±3.5 vs. 39.0±4.2 mmHg, Intact; 37.8Â±2.3 vs. 38.1±2.1 mmHg, respectively p=0.49) at room air before surgery and on the first postoperative day (p>0.05). However, a significant decrease was observed in the PaO2 (p=0.006 vs. p<0.001, respectively) and SpO2 (p<0.001 vs. p<0.001, respectively) values of the groups between the preoperative and the fifth postoperative day values. The only significant difference regarding postoperative complications, which was higher in Group 1 (p=0.003), was observed in bleeding on the first postoperative day.
Conclusion: Based on our study findings, opened pleura seems not to be associated with a higher incidence of pulmonary complications,
compared to the intact pleura.