Lung Function before and Two Days after Open-Heart Surgery

Charlotte Urell, Elisabeth Westerdahl, Hans Hedenström, Christer Janson, Margareta Emtner, Charlotte Urell, Elisabeth Westerdahl, Hans Hedenström, Christer Janson, Margareta Emtner

Abstract

Reduced lung volumes and atelectasis are common after open-heart surgery, and pronounced restrictive lung volume impairment has been found. The aim of this study was to investigate factors influencing lung volumes on the second postoperative day. Open-heart surgery patients (n = 107, 68 yrs, 80% male) performed spirometry both before surgery and on the second postoperative day. The factors influencing postoperative lung volumes and decrease in lung volumes were investigated with univariate and multivariate analyses. Associations between pain (measured by numeric rating scale) and decrease in postoperative lung volumes were calculated with Spearman rank correlation test. Lung volumes decreased by 50% and were less than 40% of the predictive values postoperatively. Patients with BMI >25 had lower postoperative inspiratory capacity (IC) (33 ± 14% pred.) than normal-weight patients (39 ± 15% pred.), (P = 0.04). More pain during mobilisation was associated with higher decreases in postoperative lung volumes (VC: r = 0.33, P = 0.001; FEV(1): r = 0.35, P ≤ 0.0001; IC: r = 0.25, P = 0.01). Patients with high BMI are a risk group for decreased postoperative lung volumes and should therefore receive extra attention during postoperative care. As pain is related to a larger decrease in postoperative lung volumes, optimal pain relief for the patients should be identified.

Figures

Figure 1
Figure 1
Lung volumes, percent of predicted values, preoperatively and on the second postoperative day, mean and SD, (n = 107). VC: vital capacity, FEV1: forced expiratory volume in 1 second, and IC: inspiratory capacity.
Figure 2
Figure 2
(a) Mean VC, 95% CI, postoperatively in percent of predictive values for patients in different age groups (n = 107; 37–60 years, n = 20; 61–70 years, n = 46; 71–80 years, n = 35; 81–86 years, n = 6);  P = 0.04 between all groups. (b) Mean IC, 95% CI, postoperatively in percent of predictive values for different genders and BMI. (n = 107, female n = 21, male n = 86, BMI ≤ 25 n = 42, BMI > 25 n = 65).
Figure 3
Figure 3
Mean VC, 95% CI, decrease in percent in relation to self-rated pain when moving from lying to sitting (n = 107, NRS 0–3.0 n = 52, NRS 3.1–7.0 n = 49, NRS 7.1–10.0 n = 6). NRS: numeric rating scale, 0 = no pain, 10 = the worst imaginable pain, VC: vital capacity,  P = 0.003 between all groups.

References

    1. Baumgarten MCS, Garcia GK, Frantzeski MH, et al. Pain and pulmonary function in patients submitted to heart surgery via sternotomy. Brazilian Journal of Cardiovascular Surgery. 2009;24(4):497–505.
    1. Bonacchi M, Prifti E, Giunti G, Salica A, Frati G, Sani G. Respiratory dysfunction after coronary artery bypass grafting employing bilateral internal mammary arteries: the influence of intact pleura. European Journal of Cardio-thoracic Surgery. 2001;19(6):827–833.
    1. Canbaz S, Turgut N, Halici U, Balci K, Ege T, Duran E. Electrophysiological evaluation of phrenic nerve injury during cardiac surgery—a prospective, controlled, clinical study. BMC Surgery. 2004;4(2, article 2)
    1. Massoudy P, Zahler S, Becket BF, Braun SL, Barankay A, Meisner H. Evidence for inflammatory responses of the lungs during coronary artery bypass grafting with cardiopulmonary bypass. Chest. 2001;119(1):31–36.
    1. Nicholson DJ, Kowalski SE, Hamilton GA, Meyers MP, Serrette C, Duke PC. Postoperative pulmonary function in coronary artery bypass graft surgery patients undergoing early tracheal extubation: a comparison between short-term mechanical ventilation and early extubation. Journal of Cardiothoracic and Vascular Anesthesia. 2002;16(1):27–31.
    1. Matte P, Jacquet L, Van Dyck M, Goenen M. Effects of conventional physiotherapy, continuous positive airway pressure and non-invasive ventilatory support with bilevel positive airway pressure after coronary artery bypass grafting. Acta Anaesthesiologica Scandinavica. 2000;44(1):75–81.
    1. Shenkman Z, Shir Y, Weiss YG, Bleiberg B, Gross D. The effects of cardiac surgery on early and late pulmonary functions. Acta Anaesthesiologica Scandinavica. 1997;41(9):1193–1199.
    1. Westerdahl E, Lindmark B, Bryngelsson I, Tenling A. Pulmonary function 4 months after coronary artery bypass graft surgery. Respiratory Medicine. 2003;97(4):317–322.
    1. Hachenberg T, Tenling A, Hansson HE, Tydén H, Hedenstierna G. The ventilation-perfusion relation and gas exchange in mitral valve disease ana coronary artery disease implications for anesthesia, extracorporeal circulation, and cardiac surgery. Anesthesiology. 1997;86(4):809–817.
    1. Tenling A, Hachenberg T, Tydén H, Wegenius G, Hedenstierna G. Atelectasis and gas exchange after cardiac surgery. Anesthesiology. 1998;89(2):371–378.
    1. Westerdahl E, Lindmark B, Eriksson T, Hedenstierna G, Tenling A. The immediate effects of deep breathing exercises on atelectasis and oxygenation after cardiac surgery. Scandinavian Cardiovascular Journal. 2003;37(6):363–367.
    1. Hulzebos EHJ, Van Meeteren NLU, De Bie RA, Dagnelie PC, Helders PJM. Prediction of postoperative pulmonary complications on the basis of preoperative risk factors in patients who had undergone coronary artery bypass graft surgery. Physical Therapy. 2003;83(1):8–16.
    1. Smetana GW, Lawrence VA, Cornell JE. Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians. Annals of Internal Medicine. 2006;144(8):581–595.
    1. Haeffener MP, Ferreira GM, Barreto SSM, Arena R, Dall’Ago P. Incentive spirometry with expiratory positive airway pressure reduces pulmonary complications, improves pulmonary function and 6-minute walk distance in patients undergoing coronary artery bypass graft surgery. American Heart Journal. 2008;156(5):900.e1–900.e8.
    1. Herdy AH, Marcchi PLB, Vila A, et al. Pre- and postoperative cardiopulmonary rehabilitation in hospitalized patients undergoing coronary artery bypass surgery a randomized controlled trial. American Journal of Physical Medicine and Rehabilitation. 2008;87(9):714–719.
    1. Renault JA, Costa-Val R, Rossetti MB. Respiratory physiotherapy in the pulmonary dysfunction after cardiac surgery. Brazilian Journal of Cardiovascular Surgery. 2008;23(4):562–569.
    1. Westerdahl E, Lindmark B, Eriksson T, Friberg O, Hedenstierna G, Tenling A. Deep-breathing exercises reduce atelectasis and improve pulmonary function after coronary artery bypass surgery. Chest. 2005;128(5):3482–3488.
    1. Urell C, Emtner M, Hedenstrom H, Tenling A, Breidenskog M, Westerdahl E. Deep breathing exercises with positive expiratory pressure at a higher rate improve oxygenation in the early period after cardiac surgery—a randomised controlled trial. European Journal of Cardio-thoracic Surgery. 2011;40(1):162–167.
    1. Hedenstrom H, Malmberg P, Agarwal K. Reference values for lung function tests in females. Regression equations with smoking variables. Clinical Respiratory Physiology. 1985;21(6):551–557.
    1. Hedenstrom H, Malmberg P, Fridriksson HV. Reference values for lung function tests in men: regression equations with smoking variables. Upsala Journal of Medical Sciences. 1986;91(3):299–310.
    1. Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. Journal of Clinical Nursing. 2005;14(7):798–804.
    1. Sasseron AB, de Figueiredo LC, Trova K, et al. Does the pain disturb the respiratory function after heart surgeries? Brazilian Journal of Cardiovascular Surgery. 2009;24(4):490–496.
    1. Akdur H, Yioit Z, Sözen AB, Çaoatay T, Güven Ö. Comparison of pre- and postoperative pulmonary function in obese and non-obese female patients undergoing coronary artery bypass graft surgery. Respirology. 2006;11(6):761–766.
    1. Jenkins SC, Moxham J. The effects of mild obesity on lung function. Respiratory Medicine. 1991;85(4):309–311.
    1. Kurki TSO, Kataja M. Preoperative prediction of postoperative morbidity in coronary artery bypass grafting. Annals of Thoracic Surgery. 1996;61(6):1740–1745.
    1. Manganas H, Lacasse Y, Bourgeois S, Perron J, Dagenais F, Maltais F. Postoperative outcome after coronary artery bypass grafting in chronic obstructive pulmonary disease. Canadian Respiratory Journal. 2007;14(1):19–24.
    1. Milgrom LB, Brooks JA, Qi R, Bunnell K, Wuestefeld S, Beckman D. Pain levels experienced with activities after cardiac surgery. American Journal of Critical Care. 2004;13(2):116–125.
    1. Mueller XM, Tinguely F, Tevaearai HT, Revelly JP, Chioléro R, Von Segesser LK. Pain location, distribution, and intensity after cardiac surgery. Chest. 2000;118(2):391–396.
    1. Bartlett RH, Gazzaniga AB, Geraghty TR. Respiratory maneuvers to prevent postoperative pulmonary complications. A critical review. Journal of the American Medical Association. 1973;224(7):1017–1021.
    1. Wrigge H, Uhlig U, Zinserling J, et al. The effects of different ventilatory settings on pulmonary and systemic inflammatory responses during major surgery. Anesthesia and Analgesia. 2004;98(3):775–781.

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