Advances in managing the noninfected open chest after cardiac surgery: Negative-pressure wound therapy

Abstract

Objective: The objective of this study was to compare safety and clinical effectiveness of negative-pressure wound therapy (NPWT) with traditional wound therapy for managing noninfected open chests with delayed sternal closure after cardiac surgery.Methods: From January 2000 to July 2015, 452 of 47,325 patients who underwent full sternotomy left the operating room with a noninfected open chest (0.96%), managed using NPWT in 214-with frequency of use rapidly increasing to near 100%-and traditionally in 238. Predominant indications for open-chest management were uncontrolled coagulopathy or hemodynamic compromise on attempted chest closure. Weighted propensity-score matching was used to assess in-hospital complications and time-related survival.Results: NPWT and traditionally managed patients had similar high-risk preoperative profiles. Most underwent reoperations (63% of the NPWT group and 57% of the traditional group), and 21% versus 25% were emergency procedures. Reexplorations for bleeding were less common with NPWT versus traditional wound therapy (n ¼ 63 [29%] vs 104 [44%], P ¼ .002). Median duration of open-chest to definitive sternal closure was 3.5 days for NPWT versus 3.1 for traditionally managed patients (P[log rank] ¼ .07). Seven patients (3.3%) were converted from NPWT to traditional therapy because of hemodynamic intolerance and 6 (2.5%) from traditional to NPWT. No NPWT-related cardiovascular injuries occurred. Among matched patients, NPWT was associated with better early survival (61% vs 44% at 6 months; P ¼ .02).Conclusions: NPWT is safe and effective for managing noninfected open chests after cardiac surgery. By facilitating open-chest management and potentially improving outcomes, it has become our therapy of choice and perhaps has lowered our threshold for leaving the chest open after cardiac surgery.

Bed-sore and Associated Factors Among Patients Admitted at Surgical Wards of Wolaita Sodo University Teaching and Referral Hospital, Southern Ethiopia

“…It improves Sodo University Teaching and Referral Hospital, Southern Ethiopia healing and prevents complications of existing pressure ulcer. This is because nurses have a responsibility to monitor patient's skin in order to plan, implement and evaluate interventions that maintain skin integrity by using their knowledge and skill [3,[13][14][15][16][17].…”

Negative pressure wound therapy in spinal fusion patients

“…There is literature to support improved wound healing with the use of closed incision negative pressure therapy (ciNPT) in multiple surgical specialties, including trauma and acute care surgery, 18,19 orthopaedics, 20,21 cardiothoracic, 22,23 vascular, 24,25 obstetrics, 26 and plastic and reconstructive surgery. 27,28 The proposed mechanisms by which ciNPT speeds wound healing include increasing blood flow, enhancing angiogenesis, stimulating growth factors, and removal of interstitial fluid.…”

Commentary: Delayed sternal closure—an open and not-so-shut case

“…Of the 300,000 patients who undergo cardiac surgery each year in North America, 1 as many as 12,000 (4%) leave the operating room with an open sternum. 2 Delayed sternal closure (DSC) was first described in 1975 by Riahi and colleagues 3 to prevent “tight mediastinal syndrome,” which is hemodynamic compromise resulting from sternal closure. Other common reasons for DSC are low cardiac output syndrome (sometimes requiring central mechanical circulatory support), bleeding, arrhythmias, and myocardial edema.…”

“…A recent randomized trial reported reduced SWI rates with the application of a negative-pressure dressing to an open sternum. Bakaeen and colleagues 2 randomly assigned 452 patients to standard DSC or negative pressure dressing. They reported SWI rates of 5% in the control group but only 2% in the intervention group, thus reducing the risk of SWI to match that of patients with primary sternal closure.…”

“…They reported SWI rates of 5% in the control group but only 2% in the intervention group, thus reducing the risk of SWI to match that of patients with primary sternal closure. 2 A randomized trial should be performed for the technique described by Balasubramanian and Bhama 8 to clarify whether a biologic barrier provides superior protection from SWI. Choice and duration of antibiotics should also be studied in a randomized fashion.…”