Website is intended for physicians
Search:

 

Abstract:

Aim: was to reveal factors that cause dyspnea in the early postoperative period after cardiac surgery.

Materials and methods: the study included 818 patients after cardiosurgical interventions in «F^S» Penza from June 2014 to February 2015, with complaints of shortness of breath at rest. The degree of influence of variables was determined using ROC analysis and logistic regression analysis.

Results: dyspnea was noted in 169 patients (19.4 %). ROC-analysis revealed a very large influence on the occurrence of dyspnoea disturbances of the mobility of the diaphragm, the great influence of the frequency of respiratory movements, the average impact of the height of diaphragm domes and low impact of body mass index. Results of logistic regression analysis showed that odds increase in 327 times at a decreased mobility of the left dome of the diaphragm 49 times in dysfunction of the right dome, 4,4-times elevation in the left dome, 3,5 times at the elevation of the right dome, 3.9 times with tachypnea and 2,6 times for severe obesity, in 1,5 times in chronic heart failure II B degree. Other factors, included in research, didn't influence on dispnea appearance.

Conclusions: a leading factor in the occurrence of dyspnea is dysfunction of the diaphragm, especially when decreased mobility of the left dome. To a lesser extent, reasons can be the elevation of diaphragm domes and tachypnea. Obesity 2 and 3 degree and chronic heart failure II B degree, had a small effect on dyspnea.

 

References

1.     American Heart Society. Dyspnea mechanisms, assessment, and management: a consensus statement. Am RevResp Crit Care Med. 1999; 159: 321-340.

2.     Parshall M.B., Schwartzstein R.M., Adams L., et al. An official American Thoracic Society statement: update on the mechanisms, assessment, and management of dyspnea. Am J Respir Crit Care Med. 2012; 185:435.

3.     Elliott M.W., Adams L., Cockcroft A., et al. The language of breathlessness. Use of verbal descriptors by patients with cardiopulmonary disease. Am Rev Respir Dis 1991;144: 826.

4.     Mahler D.A, Harver A., Lentine T., et al. Descriptors of breathlessness in cardiorespiratory diseases. Am J Respir Crit Care Med. 1996; 154:1357.

5.     Simon P.M., Schwartzstein R.M., Weiss J.W., et al. Distinguishable types of dyspnea in patients with shortness of breath. Am Rev Respir Dis. 1990; 142:1009-1014.

6.     Narin C., et al. Perioperative Considerations in Cardiac Surgery. InTech, 2012.

7.     Manning H.L., Schwartzstein R.M. Pathophysiology of Dyspnea. N Engl J Med.1995; 333:1547-1553.

8.     Schmidt M., Banzett R. B., Raux M., et al. Unrecognized suffering in the ICU: addressing dyspnea in mechanically ventilated patients. Intensive Care Medicine. 2014; 40(1): 1-10.

9.     West J.B. Pulmonary pathophysiology: the essentials (7 ed.). Baltimore: Lippincott Williams & Wilkins. 2008.

10.   Berrizbeitia L.D., Tessler S., Jacobowitz I.J., et al. Effect of sternotomy and coronary bypass surgery on postoperative pulmonary mechanics. Chest. 1989; 96(4): 873-876.

11.   Locke T.J., Griffiths T.L., Mould H., Gibson G.J. Rib cage mechanics after median sternotomy. Thorax. 1990; 45: 465-8.

12.   Shenkman Z., Shir Y, Weiss YG., et al. The effects of cardiac surgery on early and late pulmonary functions. Acta Anaesthesiol Scand. 1997; 41(9):1193-1199.

13.   Andrianova E.N., Reshetova T.G., Ryvkin A.I. i dr. Sposob diagnostiki podvizhnosti diafragmy pri bronhial'noj astme u detej [Method of diagnostics of diaphragm dome mobility in children with asthma]. Patent RU 2229845, 2004 [In Russ].

14.   Imanaka H., Kimball W.R., Wain J.C., et al. Recovery of diaphragmatic function in awake sheep after two approaches to thoracic surgery. J Appl Physiol. 1997; 83: 1733-1740.

15.   Ragnarsdуttir M., Kristjбnsdуttir Б., Ingvarsdуttir I., et al. Short-Term Changes in Pulmonary Function and Respiratory Movements after Cardiac Surgery via Median Sternotomy. Scandinavian Cardiovascular Journal. 2004; 38, 46-52.

16.   Davison A., Mulvey D. Idiopathic diaphragmatic weakness. BMJ. 1992; 304: 492-494.

17.   McCool F.D., Tzelepis G.E. Dysfunction of the Diaphragm. N Engl J Med.2012; 366: 932-942.

18.   Jaber S., Petrof B.J., Jung B., et al. Rapidly progressive diaphragmatic weakness and injury during mechanical ventilation in humans. Am J Respir Crit Care Med. 2011; 183: 364-371.

19.   Levine S., Budak M.T., Dierov J., Singhal S. Inactivity-induced diaphragm dysfunction and mitochondria-targeted antioxidants: new concepts in critical care medicine. Crit Care Med. 2011; 39:1844-1845.

20.   Levine S., Nguyen T, Taylor N., et al. Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans. N Engl J Med. 2008; 358:1327-1335.

21.   Jiao W., Zhao Y, Wang M., et al. A retrospective study of diaphragmatic motion, pulmonary function, and quality-of-life following video-assisted thoracoscopic lobectomy in patients with nonsmall cell lung cancer. Indian J Cancer. 2015; 51 2: 45-48.

22.   McCool F.D., Mead J. Dyspnea on immersion: mechanisms in patients with bilateral diaphragm paralysis. Am Rev Respir Dis. 1989; 139: 275-276.

23.   Wang C.S., Josenhaus W.T. Contribution of the diaphragmatic-abdominal displacement to ventilation in supine man. J Appl Physiol. 1971; 31: 576-580.

24.   Diehl J.L., Lofaso F., Deleuze P., et al. Clinically relevant diaphragmatic dysfunction after cardiac operations. J Thorac Cardiovasc Surg. 1994; 107:487-498.

25.   Wheatcroft M., Shrivastava V., Nyawo B., et al. Does pleurotomy during internal mammary artery harvest increase post-operative pulmonary complications? Interact Cardiovasc Thorac Surg. 2005; 4: 143-146.

26.   Canbaz S., Turgut N., Halici U., et al. Diagnosis of phrenic nerve injury after cardiac surgery. Ann Thorac Surg. 2004; 78(4): 1517.

27.   O'Brien J.W., Johnson S.H., VanSteyn S.J., et al. Effects of internal mammary artery dissection on phrenic nerve perfusion and function. Ann Thorac Surg. 1991; 52(2): 182-188.

28.   Lindenbraten L.D. Luchevaja diagnostika porazhenij diafragmy [Beam diagnostics of diaphragm lesions]. Radiologija-praktika. 2001; 2: 6-21 [ In Russ].

29.   Nason L.K., Walker C.M., McNeeley M.F., et al. Imaging of the Diaphragm: Anatomy and Function. RadioGraphics. 2012; 32: 51-70.

30.   Suwatanapongched T., Gierada D.S., Slone R.M. et al. Variation in Diaphragm Position and Shape in Adults With Normal Pulmonary Function. Chest. 2003; 123, 6: 2019-2027.

 

 

ANGIOLOGIA.ru (АНГИОЛОГИЯ.ру) - портал о диагностике и лечении заболеваний сосудистой системы