Document Type : Original Article(s)
Authors
1
Assistant Professor of Cardiac Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan
2
Assistant Professor of Cardiology, Najafabad Branch, Islamic Azad University, Isfahan
3
Intern, Najafabad Branch, Islamic Azad University, Isfahan
4
Researcher, Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan
5
General Practitioner, Delasa Heart Center, Sina Hospital, Isfahan
Abstract
Background:
Using chest tube (CT) after heart surgeries lead to effective drainage of mediastinal and plural area which is essential for preventing pericardial effusion, hemothorax and pneumothorax. The aim of this study was to assess the effects of time of extracting chest tubes after coronary artery bypass graft surgery (CABG) on clinical outcomes of surgery.
Methods:
307 patients who were candidate for coronary artery bypass graft surgery were randomly divided into groups one and two and their chest tubes were extracted respectively 24 and 48 hours after surgery with condition of drainage less than 40 cc in 4 hours. Then their pre-surgery data (age, gender, history of diabetes, myocardial infarction, stroke and left ventricular dysfunction, history of aspirin consumption, plavix, heparin and warfarin), during surgery data (time f aortic pump and klamp) and post-surgery data (number of breathes, rate of oxygen saturation, rate of pain, pain killer consumption, creation of plural effusion and pericardial effusion) were analyzed .
Findings:
The mean age of patients was 59.60 ± 9.24 years and 67.1% of them were male. There was no significant difference between two groups considering diabetes history (40.2% vs. 34.5%), myocardial infarction (45.8% vs. 36%), stroke (2.88% vs. 2%) and aspirin consumption (92.5% vs. 85%). Time of aortic pump and clamp was significantly higher in the second group (P < 0.001 and P = 0.001, respectively). The mean time of remaining of chest tubes was 22.80 ± 3.4 hours and 40.13 ± 3.58 hours in the first and second groups respectively (P < 0.001). The rate of oxygen saturation was higher in the first group; but this difference became significant in the first 24 hours after surgery (P = 0.047) and it was not significant in the second 24 hours after surgery. The mean pain was measured using Visual Analog Scale (VAS) and only until 30 hours after surgery the difference between two groups was significant (2.22 ± 2.49 vs. 2.93 ± 2.57, P = 0.016). In 7, 14 and 30 days follow-ups, no pericardial effusion was reported and the mean of happening of plural effusion was lower in the first group than the second one (3.7% vs. 5.5%, P = 0.59).
Conclusion:
Early extracting of chest tubes after coronary artery bypass graft surgery when there is no significant drainage can lead to pain reduction and consuming oxygen is an effective measure after surgery toward healing; it does not increase the risk of creation of plural effusion and pericardial effusion.
Key words:Timing, Chest tube removal, Coronary artery bypass graft surgery.
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