Advantages of autologous blood transfusion in off-pump coronary artery bypass.

BACKGROUND: In this randomized controlled study, we investigated the effects of autologous Hemobag blood transfusion (AHBT) and allogenic blood transfusion (ABT) in off-pump coronary artery bypass (OPCAB) surgery. METHODS: Sixty patients who underwent surgery between February 2008 and August 2008 were randomized into 2 groups. The AHBT group (n = 30) consisted of patients who received autologous Hemobag blood transfusion, and the ABT group (n = 30) consisted of patients who received allogenic blood transfusion. All patients underwent OPCAB via sternotomy. The time to extubation, chest tube drainage volume, postoperative white blood cell counts, amount of blood transfusion, sedimentation rate, C-reactive protein concentration, postoperative temperature, and the presence of atelectasis were recorded in the intensive care unit. RESULTS: Intraoperative bleeding and fluid resuscitation were similar in the 2 groups (P > .05); however, there were significant decreases in postoperative blood loss, extubation period, postoperative white cell counts, sedimentation rate, incidence of atelectasis, C-reactive protein, and fever in the AHBT group compared with the ABT group (P < .05). The rate of atrial fibrillation in the AHBT group tended to be lower than in the ABT group. CONCLUSION: Autologous blood transfusion in OPCAB may be beneficial in certain cardiac surgery patients; however, these beneficial effects require further study to be proved.

Chest physical therapy for patients in the intensive care unit.

Chest physical therapy is used in the intensive care unit (ICU) to minimize pulmonary secretion retention, to maximize oxygenation, and to reexpand atelectatic lung segments. This article reviews how chest physical therapy is used with patients who are critically ill. A brief historical review of the literature is presented. Chest physical therapy treatments applicable to patients in the ICU are discussed. Postural drainage, percussion, vibration, breathing exercises, cough stimulation techniques, and airway suctioning are described in detail, with current references. The importance of patient mobilization is emphasized. The advantages of chest physical therapy over therapeutic bronchoscopy also are discussed. Two patient examples are used to demonstrate the beneficial effects that may be obtained with chest physical therapy. Following the removal of retained secretions, arterial oxygenation and partial pressure of arterial oxygen/fraction of inspired oxygen concentration ratios improved, and atelectasis resolved without the negative hemodynamic side effects of therapeutic bronchoscopy. Physical therapists trained in the ICU can safely perform chest physical therapy with the majority of patients who are critically ill.