Document Detail

Site of pleural drain insertion and early postoperative pulmonary function following coronary artery bypass grafting with internal mammary artery.
MedLine Citation:
PMID:  10084489     Owner:  NLM     Status:  MEDLINE    
STUDY OBJECTIVES: Coronary artery bypass graft (CABG) surgery using the left internal mammary artery (LIMA) impairs postoperative pulmonary function. We studied the changes in pulmonary function and subjective pain relative to the site of chest tube insertion. DESIGN: Thirty patients undergoing CABG surgery using the LIMA were randomized into two groups. Group A (n = 15) received a left chest tube inserted from the midline (subxyphoid). Group B (n = 15) had a tube placed in the sixth intercostal space at the anterior axillary line. All of the patients underwent bedside pulmonary function testing preoperatively and on postoperative days (PODs) 1, 3, and 5. Pain sensation was quantified by a standardized score (1 to 10). RESULTS: A significant impairment of pulmonary function parameters was observed in both groups until POD 5. For group A, the decline in percent predicted (+/-SD) in the vital capacity (VC) from before surgery to POD 5 was, respectively, 92.3+/-30.6% to 56.9+/-12.6% (p < 0.001). For group B, the decline in the VC was from 88.0+/-18.2% to 55.5+/-14.8% (p < 0.001). The FEV1 declined concomitantly in group A from 86.2+/-18.2% to 50.8+/-12.1%, and in group B from 83.5+/-16.4% to 53.9+/-12.5% (p < 0.001). On POD 1, a significantly lower decrease in the VC was measured in group A than in group B, respectively: 45.3+/-15.5% vs 28.6+/-8.7% (p < 0.001). A significantly lower decrease in the FEV1 was also seen in group A than in group B, respectively: 36.9+/-12.9% vs 28.0+/-10.6% (p < 0.05). Pain experienced during deep inspiration was also significantly less in group A than in group B, respectively: 1.2+/-1.1 vs 2.5+/-0.9 (p < 0.01). CONCLUSIONS: Subxyphoid insertion of the pleural drain leads to a significantly lower impairment of pulmonary function and less subjective pain than insertion at the intercostal position. The drainage of the left pleural space is equally effective with both techniques.
C Hagl; W Harringer; B Gohrbandt; A Haverich
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Chest     Volume:  115     ISSN:  0012-3692     ISO Abbreviation:  Chest     Publication Date:  1999 Mar 
Date Detail:
Created Date:  1999-04-14     Completed Date:  1999-04-14     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  757-61     Citation Subset:  AIM; IM    
Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Germany.
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MeSH Terms
Carbon Dioxide / blood
Chest Tubes
Coronary Disease / surgery
Internal Mammary-Coronary Artery Anastomosis*
Middle Aged
Oxygen / blood
Pain, Postoperative
Postoperative Period
Respiratory Function Tests
Respiratory Mechanics*
Thoracostomy / methods*
Reg. No./Substance:
124-38-9/Carbon Dioxide; 7782-44-7/Oxygen

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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