Original Article
Respiratory function after cardiac surgery*

https://doi.org/10.1016/S1053-0770(96)80130-3Get rights and content

Study Objective:

Cardiac surgery is complicated by decreased postoperative respiratory muscle strength and spirometry with accompanying increased atelectasis. The specific respiratory symptoms attributable to these physiologic changes are unknown, and this study looked at the symptoms and underlying physiology.

Design:

Convenience sampling of observational cohort.

Setting:

Tertiary care university hospital.

Patients:

One hundred thirty-eight patients undergoing elective surgery were enrolled.

Interventions:

Changes from admission to 8-week postoperative values in atelectasis, pleural effusions, spirometry (forced vital capacity and forced expiratory volume in one second), and respiratory muscle strength (negative inspiratory pressure) were measured. These physiologic changes were compared with changes in respiratory symptoms of cough, wheeze, phlegm, and dyspnea on walking up a slight hill noted from admission to 8-week follow-up by stepward logistic regression.

Measurements and Results:

Spirometry and negative inspiratory pressure decreased and atelectasis increased from admission to discharge. These disturbances had only incompletely resolved at 8-week follow-up. Some patients reported fewer symptoms of cough (11%), phlegm (9%), wheeze (35%), and dyspnea (46%) at 8 weeks follow-up. Other patients reported increased symptoms of cough (15%), phlegm (10%), wheeze (6%), and dyspnea (4%) at 8 weeks follow-up. Residual atelectasis at 8 weeks was predictive of fewer symptoms of dyspnea (odds ratio [OR] 0.335, p = 0.199; 95% confidence interval [CI] 0.188, 0.597], increased symptoms of dyspnea (OR 855, p = 0.006; 95% CI 6.6, 11052), and increased symptoms of cough (OR 260, p = 0.023; 95% CI 2.13, 31829). Negative inspiratory pressure at 8 weeks was predictive of fewer symptoms of dyspnea (OR 1.05, p = 0.032; 95% CI 1.02, 1.09) and increased symptoms of wheeze (OR 0.7, p = 0.45; 95% CI 0.533, 0999). Forced vital capacity at 8 weeks was predictive of increased symptoms of wheeze (OR 0.005; p = 0.015; 95% CI 0.0060, 0.775).

Conclusions:

Postoperative changes in respiratory muscle strength and spirometry can persist up to at least 8 weeks postoperatively. Many patients report a change in respiratory symptoms of cough, phlegm, dyspnea, or wheeze. The change in respiratory symptoms at 8 weeks is correlated with residual respiratory muscle weakness, decrease in spirometry, and residual atelectasis.

References (28)

Cited by (56)

  • Clinical strategies to prevent pulmonary complications in cardiac surgery: An overview

    2015, Journal of Cardiothoracic and Vascular Anesthesia
    Citation Excerpt :

    In contrast, a more recent prospective trial by Oz et al in 240 patients found significant decreases in hospital stay and costs when pleural integrity was preserved.71 Only limited clinical data are available about the alteration of chest wall mechanics and its consequences on respiratory function due to sternotomy.72–76 Additionally, the choice of surgical instruments may have an impact.

  • Adhesive-enhanced sternal closure to improve postoperative functional recovery: A pilot, randomized controlled trial

    2011, Annals of Thoracic Surgery
    Citation Excerpt :

    Among the most frequent causes of postoperative morbidity and death after cardiac operations are respiratory dysfunction and pulmonary complications [20]. Sternotomy results in significant postoperative atelectasis and reduced pulmonary function for more than 8 weeks after the operation [21]. Pain may be partly responsible for this reduced pulmonary function because patients with adhesive-enhanced closure showed much earlier improvement to baseline in inspiratory capacity.

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*

Supported in part by a grant from the Saskatchewan Health Utilization and Assessment Council and Canadian Heart and Stroke Foundation.

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