Thesis (MScPhysio)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Aim: The aim of this study is to determine if the addition of a pre-extubation recruitment
manoeuvre to standard care is safe and will improve lung compliance and subsequent
PaO2/FiO2 (PF ratio) after extubation in postoperative coronary artery bypass graft surgery
patients.
Design: Prospective, triple blind, randomised, controlled trial.
Method: This study was conducted in a private hospital in the Northern suburbs of Cape
Town, South Africa. All patients admitted between 03/10/2010 and 22/11/2011, for
uncomplicated elective coronary artery bypass graft (CABG) surgery were eligible for
inclusion into the study. Patients were randomly allocated into either the intervention group
or the control group. The intervention group received a gradual build-up lung recruitment
manoeuvre (RM). The primary outcome was PaO2/FiO2 (PF ratio). The secondary outcomes
were safety and static lung compliance. ICU length of stay (LOS) and hospital LOS were
also recorded. The pre-RM hemodynamic stability of the patient was checked before the
intervention and repeated at 5 minutes after the intervention by the nursing sister. Data to
calculate static lung compliance was captured at the same time. Criteria for safety and
discontinuation of the RM were monitored during the intervention by the principle investigator
only.
Results: Of the 69 patients eligible for the study 47 were randomly allocated into the
intervention group (n=22) and control group (n=25) respectively. Groups were the same at
baseline with regards to sex, pulmonary risk, sedation and surgical procedures. The RM
could be completed in all patients. The prior defined criteria for discontinuation of the RM
were not reached in any of the patients. No adverse effects were noted. The PaO2/FiO2 (PF
ratio) decreased significantly in both groups from pre-surgery measurements compared to
when measured before the RM (p<0.001). There was a tendency noted for the intervention
group to return to pre-surgery measurements of PF ratio within 12 hours after extubation
when compared to the control group. There was no significant difference between the
groups from extubation to 24 hours (p = 0.6). The static compliance improved at 5 minutes
following the RM (p<0.001) and remained improved until extubation (p<0.001) for the
intervention group. No difference was noted in the static compliance of the control group
over the same time period. The mean hospital length of stay for the intervention group was
8.61 (95% confidence interval 7.26 to 9.96 days) and 10.08 (95% confidence interval 8.52 –
11.63 days) for the control group. Conclusion: A gradual recruitment manoeuvre at 30cmH2O 30minutes before extubation
significantly improved static lung compliance within 5 minutes with no adverse hemodynamic
side effects. There was noted maintained improved PF ratio at extubation or immediately
afterwards for the intervention group and no difference in the PF ratio between the
intervention group and control group. / AFRIKAANSE OPSOMMING: Doel: Die doel van hierdie studie is om te bepaal of die toevoeging van ’n pre-ekstubasie
herwinningstegniek tot standaard sorg veilig is, en of dit longvervormbaarheid en gevolglike
PaO2/FiO2 (PF-verhouding) na ekstubasie in post-operatiewe kroonaaromleidingchirurgiepasiënte
sal verbeter.
Ontwerp: Prospektiewe, trippel-blinde, ewekansige, gekontroleerde proefneming.
Metode: Hierdie studie is uitgevoer in ’n privaat hospitaal in die noordelike voorstede van
Kaapstad, Suid-Afrika. Alle pasiënte wat tussen 03/10/2010 en 22/11/2011 gehospitaliseer is
vir ongekompliseerde elektiewe kroonaaromleidingchirurgie, kon in aanmerking kom vir die
studie. Pasiënte is op ewekansige wyse ingedeel in die intervensie- en kontrolegroepe. ’n
Geleidelike-opbou-van-druk-longherwinningstegniek (HT) is op die intervensiegroep
toegepas. Die primêre uitkoms was die PaO2 /FiO2 (PF-verhouding). Die sekondêre uitkoms
was veiligheid en statiese longvervormbaarheid. ISE-verblyf en hospitaalverblyf is ook
genoteer. Die navorsingsassistent het data van bestaande eenheiddokumentasie geneem.
Die pre-HT-hemodinamiese stabiliteit van die pasiënte is gemonitor voor en weer 5 minute
na die intervensie. Inligting om die statiese longvervormbaarheid te bereken is terselfdertyd
genoteer. Kriteria vir veiligheid en vir die staking van die HT is gemonitor tydens uitvoering
deur die primêre ondersoeker en die verpleegkundige.
Resultate: Van die 69 pasiënte wat in aanmerking kon kom vir die studie is 47 op
ewekansige wyse ingedeel in die intervensiegroep (n=22) en die kontrolegroep (n=25). Die
groepe was dieselfde by die basislyn. Die herwinningstegniek kon volledig op alle pasiënte
uitgevoer word. Die vooraf gedefinieerde kriteria vir staking van die HT is met geen pasiënte
bereik nie. Geen nadelige uitwerking is genoteer nie. Die PaO2 /FiO2 (PF-verhouding) het
beduidend verminder in beide groepe van pre-operatiewe metings in vergelyking met meting
voor die HT (p<0.001). ‘n Neiging is genoteer dat die intervensiegroep binne 12 uur na
ekstubasie tot pre-chirurgie PF-metings teruggekeer het. Daar was geen merkbare verskil
tussen die groepe vanaf ekstubasie tot 24 uur (p=0.6) nie. Die statiese vervormbaarheid het
verbeter teen 5 minute na HT (p<0.001) en het verbeter gebly tot ekstubasie (p<0.001) vir
die intervensiegroep. Daar was geen verskil in die statiese vervormbaarheid van die
kontrolegroep nie. Die gemiddelde hospitaalverblyf vir die intervensiegroep was 8.61 (95%
betroubaarheidsinterval 7.26 tot 9.96 dae) en 10.08 (95% betroubaarheidsinterval 8.52 –
11.63 dae) vir die kontrolegroep. Gevolgtrekking: ’n Geleidelike herwinningstegniek teen 30cmH2O 30 minute voor
ekstubasie het statiese longvervormbaarheid beduidend verbeter binne 5 minute, met geen
nadelige hemodinamiese newe-effekte nie. Daar was geen verskil in die oksigenasie-indeks
tussen die intervensie- en kontrolegroep na ekstubasie nie.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/85871 |
| Date | 12 1900 |
| Creators | Nel, Stephanus Gerhardus |
| Contributors | Hanekom, S. D., Coetzee, Andre, Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. |
| Publisher | Stellenbosch : Stellenbosch University |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | English |
| Type | Thesis |
| Format | 67 p. : ill. |
| Rights | Stellenbosch University |
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