Why the study?
Left internal mammary artery harvesting during CABG often requires left pleural drain insertion, which can lead to pain, discomfort, and respiratory issues.
Does subxiphoid left pleural drain insertion reduce postoperative ventilator support duration and pain scores compared to intercostal left pleural drain insertion in patients undergoing CABG surgery?
Does subxiphoid left pleural drain insertion reduce postoperative ventilator support duration and pain scores compared to intercostal left pleural drain insertion in patients undergoing CABG surgery?
Subxiphoid pleural drain insertion after CABG is associated with shorter ventilation times, lower pain scores, and improved pulmonary function compared to intercostal drain placement.
Subxiphoid drain insertion may shorten ventilation time and reduce pain after CABG; extends meta-analytic support for preferring it over intercostal placement.
Coronary artery bypass grafting (CABG), a prevalent surgery for coronary artery disease, often involves left internal mammary artery harvesting, necessitating left pleural drain insertion. This can lead to pain, discomfort, and respiratory issues. This analysis compares outcomes between subxiphoid and intercostal left pleural drain insertion. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, this systematic review and meta-analysis involved searches in MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, Google Scholar, and Clinical Trial Registry. Studies were selected based on primary outcomes (postoperative ventilator support duration and pain score) and secondary outcomes (percentage predicted vital capacity (VC), forced VC (FVC), and partial pressure of oxygen (PO2) in arterial blood gas (ABG) analysis). Statistical analysis used a random effect model, pooled risk ratio, and I2 heterogeneity. Nine studies (seven randomized and two nonrandomized) with 412 patients met the inclusion criteria. Pooled analysis indicated reduced ventilation time and postoperative pain with the subxiphoid drain compared to the intercostal drain. Spirometry parameters showed improved VC, FVC, and PO2 in ABG analysis. This meta-analysis suggests that subxiphoid pleural drain insertion in CABG patients is associated with shorter ventilation times, lower pain scores, and improved pulmonary function compared to intercostal drain placement.
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Mehsare et al. (2024) studied this question.
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