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J Cardiothorac Vasc Anesth. 2017 Dec;31(6):2010-2016. doi: 10.1053/j.jvca.2016.12.005. Epub 2016 Dec 7.

Prevalence and Implications of Abnormal Respiratory Patterns in Cardiac Surgery: A Prospective Cohort Study.

Author information

1
Department of Anesthesia and Intensive Care, Academician EN Meshalkin Novosibirsk State Budget Research Institute of Circulation Pathology, Novosibirsk, Russia. Electronic address: d_ponomarev@meshalkin.ru.
2
Department of Physiology, Academician EN Meshalkin Novosibirsk State Budget Research Institute of Circulation Pathology, Novosibirsk, Russia.
3
Department of Anesthesia and Intensive Care, Academician EN Meshalkin Novosibirsk State Budget Research Institute of Circulation Pathology, Novosibirsk, Russia.
4
Department of Cardiac Surgery, Academician EN Meshalkin Novosibirsk State Budget Research Institute of Circulation Pathology, Novosibirsk, Russia.
5
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.

Abstract

OBJECTIVE:

To investigate the prevalence and impact of abnormal respiratory patterns in cardiac surgery patients.

DESIGN:

Prospective cohort study.

SETTING:

Tertiary hospital.

PARTICIPANTS:

Patients scheduled for elective coronary artery bypass graft surgery.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Pulmonary function tests were performed in 454 patients before surgery. Abnormal respiratory patterns were defined as follows: obstructive (forced expiratory volume in 1 s [FEV1]/forced vital capacity [FVC]<0.70), restrictive (FEV1/FVC≥0.70 and FVC<80% of predicted), and mixed (FEV1/FVC<0.70 and both FEV1 and FVC<80% of predicted). Of the 31 patients with a history of chronic obstructive pulmonary disease, no abnormal respiratory pattern was confirmed in 5. Of the 423 patients without a history of lung disease, the authors newly identified 57 obstructive, 46 restrictive, and 4 mixed patterns. Therefore, lung disease was reclassified in 24.7% of cases. Independent predictors of obstructive pattern were age, male sex, history of smoking, and chronic obstructive pulmonary disease. Obstructive lung disease was associated with 16 hours or longer ventilation. A reduced FEV1 was associated with a likelihood of atrial fibrillation (1-L decrement, odds ratio: 1.38, 95% confidence interval: 1.01-to-1.90, p = 0.04) and hospitalization time (regression coefficient: 1.23, 95% confidence interval: 0.54-to-1.91, p<0.001).

CONCLUSIONS:

Abnormal respiratory patterns are common and often underdiagnosed in the cardiac surgery setting. Pulmonary function tests help reveal patients at risk of complications and may provide an opportunity for intervention.

KEYWORDS:

cardiac surgery; chronic obstructive pulmonary disease; obstructive respiratory pattern; pulmonary function tests; restrictive respiratory pattern

PMID:
28242146
DOI:
10.1053/j.jvca.2016.12.005
[Indexed for MEDLINE]

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