• Sandra Simon, Christian Coronel, Adriana Silveira de Almeida, and Aline Marcadenti.
• MSc. Registered Nurse, Graduate Program in Health Sciences (Cardiology), Instituto de Cardiologia, Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre (RS), and Registered Nurse, Cardiology and Cardiac Surgery Services, Hospital Nossa Senhora da Conceição Hospital (HNSC), Porto Alegre (RS), Brazil.
• Sao Paulo Med J. 2019 May 8; 137 (1): 667466-74.

BackgroundThe pleural drain insertion site after coronary artery bypass graft (CABG) surgery may alter lung function, especially respiratory muscle strength. The main objective of this study was to compare the effectiveness and safety of use of the left lateral intercostal region versus the subxiphoid position for pleural drainage during elective CABG surgery using extracorporeal circulation (ECC).Design And SettingRandomized trial conducted in a tertiary-level hospital in Porto Alegre, Brazil.Methods48 patients were assigned to group 1 (pleural drain in the left lateral intercostal region) or group 2 (pleural drain in the subxiphoid position). Respiratory muscle strength was measured in terms of maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP), in cmH2O, by means of manovacuometry preoperatively, 24 and 72 hours after drain removal and before discharge from hospital. Painand dyspnea scales, presence of infections, pleural effusion and atelectasis, duration of drain use, drainage volumes and surgical reinterventions were also evaluated.ResultsAfter adjustments, there were no significant differences between the groups at the end of the study (before discharge), in predicted percentages either for MIP (delta group 1: -17.21% versus delta group 2: -22.26%; P = 0.09) or for MEP (delta group 1: -9.38% versus delta group 2: -13.13%; P = 0.17). Therewere no differences between the groups in relation to other outcomes.ConclusionThere was no difference in maximal respiratory pressures in relation to the pleural drain insertion site among patients who underwent CABG surgery using ECC.Trial RegistrationReBEc V1111.1159.4447.

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