Effect of pleurotomy on pulmonary function after median sternotomy.

To determine whether pleurotomy during median sternotomy worsens postoperative pulmonary function, patients whose pleurae remained intact (N = 7) were compared with those whose pleural spaces were entered during median sternotomy (N = 31). Thirty-eight adults performed spirometry and N2 washout to determine functional residual capacity preoperatively and 2, 24, 48, and 72 hours after extubation. Two mediastinal drainage tubes were placed in every patient; no pleural drainage tubes were inserted. Chest roentgenograms were performed preoperatively and 24 and 72 hours after extubation. Preoperatively, functional residual capacity, forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and FEV1/FVC did not differ between groups. Postoperatively, in all patients developed a restrictive pulmonary defect, but mean functional residual capacity, FVC, FEV1 and FEV1/FVC did not differ between groups. In contrast to earlier reports, entering the pleural space did not worsen the restrictive pulmonary defect that results from median sternotomy when direct pleural drainage was avoided.