CHEST TUBE REMOVAL TIMING: EFFECT ON OUTCOME AFTER A CORONARY ARTERY BYPASS GRAFT SURGERY
Gamal Abdel-Shafy Ibrahim Farag
Department Cardiothoracic Surgery, Faculty of Medicine, Al-Azhar University
Background: Optimal timing of chest tube (CT) removal after coronary artery bypass graft surgery is not determined. Aim of the work: To evaluate the effect of early removal of chest drains after coronary artery bypass graft surgery on early postoperative outcome including pain, pulmonary functions, and incidence of postoperative complications. Patients and Methods: We conducted a prospective study on 64 patients who underwent coronary artery bypass graft surgery in Al-Azhar University hospitals. The patients were randomized into two groups: in group 1 (N=32) patient's CTs were removed within the first 24 hours after surgery, whereas in group 2 (N=32) patient's CTs were removed in the second 24 hours after surgery if chest tube drainage was less than 40 cc per 4 hour. The anesthetic and surgical techniques were identical in both groups. The following data were collected and included in statistical analysis: demographic data, left ventricular ejection fraction (LVEF) before surgery, respiratory rate, oxygen saturation, pain level according to visual analogue scale (VAS), analgesic administration, pleural effusion and length of ICU stay. Results: There were statistically significant increases of cross clamp time, pump time, and CT drainage volume in the first 24 hours in late group compared to early group. In addition, there was statistically significant increase of PaCO2 at 12 and 24 hours postoperatively and significant decrease of PaO2 at 12 hours in late group compared to early group. Also, oxygen saturation was significantly lower in late group at 24 and 48 hours compared to early group. Finally, ICU stay was significantly shorter in early compared to late group. There was statistically insignificant difference between early and late groups at different studied times as regard to pain except significant decrease of VAS in early group compared to late group at 36, 42, and 48 hours (1.37±0.65, 0.96±0.59, and 0.75±0.62 vs. 2.34±0.60, 1.62±0.83, and 1.12±0.60 respectively). Conclusion: The optimal time for removal of chest tube after coronary artery bypass graft surgery may be early (within first 24 hours). However, it needed to be validated in future studies with large number of patients.