Thoracic alterations after cardiac surgery

Carter, A. R.; Sostman, Henry Dirk; Curtis, Anne McB.; Swett, Henry A.

doi:10.2214/ajr.140.3.475

Cited by 46 publications

(18 citation statements)

References 14 publications

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“…Pleural effusions may be the result of congestive heart failure, postsurgical hemorrhage, iced saline cardioplegia solution, and entry of mediastinal blood through unrecognized pleural tears (45)(46)(47). Preoperative collections of pleural fluid are usually drained at the time of surgery so that the postoperative development of pleural effusions should prompt an attempt to identify a causative factor (5).…”

Section: Posttransplant Considerationsmentioning

confidence: 99%

The pleural space and organ transplantation.

Judson

Sahn²

1996

Am J Respir Crit Care Med

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Pleural disease both before and after organ transplantation has important implications. Pleural effusions are common in candidates for heart, liver, and kidney transplantation. A thoracentesis is not mandatory in these patients, but it should be performed if clinical or radiologic features suggest that the effusion is not the result of organ failure. Posttransplant pleural infections and pleural PTLD relate to the level and duration of immunosuppression and are probably not organ-specific. Organ-specific pleural complications include pleural effusion from hepatic venoocclusive disease, spontaneous pneumothorax associated with obstructive airway disease from chronic GVHD after bone marrow transplantation, and early pleural effusion from urinothorax and late effusion from perirenal lymphocele years after kidney transplantation. The treatment of pleural disease in potential lung transplant candidates should minimize the extent of pleurodesis. Pleural effusions are expected sequelae after lung transplantation, and they may be harbingers of acute rejection. Interpleural communication, an expected finding after heart-lung transplantation or double-lung transplantation with a "clamshell" incision, has therapeutic implications.

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Section: Posttransplant Considerationsmentioning

confidence: 99%

The pleural space and organ transplantation.

Judson

Sahn²

1996

Am J Respir Crit Care Med

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“…Sternal dehiscence is an uncommon but serious complication of median sternotomy, with an estimated prevalence of 1-2% [1][2][3][4]. Predisposing factors include chronic obstructive pulmonary disease, obesity, diabetes mellitus, prolonged bypass time during surgery, internal mammary artery grafting, repeated surgery for mediastinal bleeding, and prolonged postoperative ventilation [1].…”

Section: Discussionmentioning

confidence: 99%

“…Predisposing factors include chronic obstructive pulmonary disease, obesity, diabetes mellitus, prolonged bypass time during surgery, internal mammary artery grafting, repeated surgery for mediastinal bleeding, and prolonged postoperative ventilation [1]. Prompt diagnosis is important for successful management [1][2][3][4][5][6][7].…”

Section: Discussionmentioning

confidence: 99%

“…Although the diagnosis is often evident from the physical examination findings, sternal dehiscence may be clinically occult in some patients [1][2][3][4][5][6][7]. Thus, there has been a longstanding interest in determining whether radiography could be used in identifying this complication [8][9][10].…”

Section: Discussionmentioning

confidence: 99%

“…However, this sign is rarely observed in patients with this complication and does not add incremental value to the finding of sternal wire displacement in establishing the diagnosis of dehiscence. ternal dehiscence is an uncommon but serious complication of median sternotomy [1][2][3][4][5][6][7]. The interest in establishing the radiographic diagnosis of this complication is long-standing [8][9][10].…”

Section: Original Reportmentioning

confidence: 99%

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A Closer Look at the Midsternal Stripe Sign

Boiselle

Mansilla²

2002

American Journal of Roentgenology

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Effect of an Incentive Spirometer Patient Reminder After Coronary Artery Bypass Grafting

et al. 2019

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IMPORTANCE Incentive spirometers (ISs) were developed to reduce atelectasis and are in widespread clinical use. However, without IS use adherence data, the effectiveness of IS cannot be determined.OBJECTIVE To evaluate the effect of a use-tracking IS reminder on patient adherence and clinical outcomes following coronary artery bypass grafting (CABG) surgery. DESIGN, SETTING, AND PARTICIPANTSThis randomized clinical trial was conducted from June 5, 2017, to December 29, 2017, at a tertiary referral teaching hospital and included 212 patients who underwent CABG, of whom 160 participants were randomized (intent to treat), with 145 completing the study per protocol. Participants were stratified by surgical urgency (elective vs nonelective) and sex (men vs women).INTERVENTIONS A use-tracking, IS add-on device (SpiroTimer) with an integrated use reminder bell recorded and timestamped participants' inspiratory breaths. Patients were randomized by hourly reminder "bell on" (experimental group) or "bell off" (control group). MAIN OUTCOMES AND MEASURESIncentive spirometer use was recorded for the entire postoperative stay and compared between groups. Radiographic atelectasis severity (score, 0-10) was the primary clinical outcome. Secondary respiratory and nonrespiratory outcomes were also evaluated.RESULTS A total of 145 per-protocol participants (112 men [77%]; mean age, 69 years [95% CI, 67-70]; 90 [62%] undergoing a nonelective procedure) were evaluated, with 74 (51.0%) in the bell off group and 71 (49.0%) in the bell on group. The baseline medical and motivation-torecover characteristics of the 2 groups were similar. The mean number of daily inspiratory breaths was greater in bell on (35; 95% CI, 29-43 vs 17; 95% CI, 13-23; P < .001). The percentage of recorded hours with an inspiratory breath event was greater in bell on (58%; 95% CI, 51-65 vs 28%; 95% CI, 23-32; P < .001). Despite no differences in the first postoperative chest radiograph mean atelectasis severity scores (2.3; 95% CI, 2.0-2.6 vs 2.4; 95% CI, 2.2-2.7; P = .48), the mean atelectasis severity scores for the final chest radiographs conducted before discharge were significantly lower for bell on than bell off group (1.5; 95% CI, 1.3-1.8 vs 1.8; 95% CI, 1.6-2.1; P = .04). Of those with early postoperative fevers, fever duration was shorter for bell on (3.2 hours; 95% CI, 2.3-4.6 vs 5.2 hours; 95% CI, 3.9-7.0; P = .04). Having the bell turned on reduced noninvasive positive pressure ventilation use rates (37.2%; 95% CI, 24.1%-52.5% vs 19.2%; 95% CI, 10.2%-33.0%; P = .03) for participants undergoing nonelective procedures. Bell on reduced the median postoperative length of stay (7 days; 95% CI, 6-9 vs 6 days; 95% CI, 6-7; P = .048) and the intensive care unit length of stay for patients undergoing nonelective procedures (4 days; 95% CI, 3-5 vs 3 days; 95% CI, 3-4; P = .02). At 6 months, the bell off mortality rate was higher than bell on (9% vs 0%, P = .048) for participants undergoing nonelective procedures. CONCLUSIONS AND RELEVANCEThe incentive spirome...

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Thoracic alterations after cardiac surgery

Cited by 46 publications

References 14 publications

The pleural space and organ transplantation.

The pleural space and organ transplantation.

A Closer Look at the Midsternal Stripe Sign

Effect of an Incentive Spirometer Patient Reminder After Coronary Artery Bypass Grafting

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