Respiratory Function and Arterial Blood Gas Outcomes in On-Pump versus Off-Pump Coronary Artery Bypass Graft Patients

Abstract

This review aims to compare the outcomes of preoperative respiratory rehabilitation in patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (on-pump) versus without cardiopulmonary bypass (off-pump). The focus is on the reduction of postoperative pulmonary complications (PPCs) and improvements in pulmonary function and arterial blood gases.

Seven randomized controlled trials (RCTs) met the inclusion criteria for this review, drawn from an initial screening of 13 citations. One study presented a combined analysis of two trials, resulting in data from seven distinct trials explicitly comparing pulmonary function and arterial blood gas outcomes between on-pump and off-pump CABG patients. Several studies emphasized the potential benefits of integrating preoperative respiratory rehabilitation with surgical approaches to improve patient outcomes.

Pulmonary dysfunction remains a significant adverse consequence of cardiopulmonary bypass (CPB), contributing to postoperative morbidity. Off-pump coronary artery bypass grafting (OPCAB) has gained popularity in recent years due to its association with fewer pulmonary complications. Multiple studies report marked improvements in postoperative pulmonary function tests in OPCAB patients, including higher oxygen saturation (SpO2 > 95%) and reduced extubation times (<48 hours), compared to those undergoing on-pump CABG.

Preoperative respiratory rehabilitation in CABG patients significantly reduces the risk of PPCs, shortens hospital stays, and facilitates earlier extubation. These findings support the incorporation of respiratory rehabilitation, including inspiratory muscle training, into routine preoperative care to enhance patient recovery. Further research is needed to assess the efficacy of combined physiotherapy interventions in patients undergoing CABG.