The role of peak expiratory flow value in predicting clinical outcomes in cardiothoracic surgery
Prediction of postoperative pulmonary and clinical outcomes in adult patients undergoing coronary artery bypass grafting or cardiac valve surgery.
This is a single-center prospective observational cohort study to be conducted at the Department of Anesthesiology and Reanimation, University of Health Sciences Gülhane Training and Research Hospital, Ankara, Turkey. Consecutive adult patients (aged 18–75 years) scheduled for elective coronary artery bypass grafting and/or cardiac valve surgery who meet eligibility criteria will be enrolled following written informed consent. The exposure of interest is preoperative peak expiratory flow (PEF). PEF will be measured at the bedside during the preoperative pulmonary evaluation using a handheld peak flow meter, with the patient in a seated position, under continuous ECG monitoring. Three consecutive measurements will be obtained according to standard technique, and the highest of the three values will be recorded in milliliters per minute as the participant's PEF value. No therapeutic intervention will be administered as part of the study; all clinical care, surgical management, anesthesia, and postoperative care will follow institutional standards and will not be modified by the protocol. Baseline data collected at enrollment will include demographic information (age, sex), comorbidities, diagnosed pulmonary disease and its current control status (chronic obstructive pulmonary disease, asthma, pulmonary thromboembolism, interstitial lung disease, and other restrictive lung diseases), history of pulmonary treatment and inhaler regimen (short- and long-acting beta-agonists, muscarinic antagonists, and inhaled corticosteroids), preoperative PEF, and planned surgical type stratified by pump requirement (on-pump CABG, off-pump CABG, conventional cardiac valve surgery, and minimally invasive cardiac valve surgery). Participants will be followed throughout their hospital stay. Outcome data collected will include intensive care unit length of stay, requirement and duration of invasive mechanical ventilation, requirement and duration of non-invasive mechanical ventilation, r
1. Age 18–75 years 2. Scheduled for coronary artery bypass grafting and/or cardiac valve surgery 3. Preoperative pulmonary (chest diseases) evaluation available 4. Cardiologically stable as confirmed by the cardiology department 5. ECG monitoring available during peak expiratory flow measurement
1. Emergency surgery 2. Emergency preoperative evaluation or evaluation performed at an external center 3. Postoperative transfer to another center 4. History of prior thoracic surgery 5. Significant thoracic deformity 6. Unstable angina 7. Severe and/or advanced aortic stenosis 8. History of myocardial infarction within the past 1 month 9. Presence of aortic aneurysm