Tuesday, January 24, 2012

Sternal Wound Stability (& the Pillow)

Aggressive coughing and deep breathing maneuvers, which frequently initiates coughing, are important for purging the lungs of fluid and inflating the lungs to prevent atelectasis and pneumonia. These maneuvers are initiated in the hospital and are a mandatory part of post discharge respiratory therapy.  Percussive expansion associated with coughing puts extreme stress on the sternal wound. Ambulating, getting into and out of bed or chairs or cars, bowel movements and other normal activities also place strain on the surgical wound site.While patients experience this stress on their surgical wound as pain and the feeling that they are "coming apart," the clinical result may in fact be grave: dehiscence and mediastinal infection.

Sternal stability is crucial in preventing these severe sternal wound complications. Traditionally, prophylactic methods used to achieve sternal stability following a sternotomy has been available only to the extent that folded sheets, towels, a pillow or a teddy bear could be used to "splint" the surgical wound.   These methods, while providing an inward pressure to the sternum, provides no encircling support to the rib cage and chest wall during coughing, is unavailable to the patient when ambulating, and provides no lateral support to stabilize the surgical wound.

Without support, the pain of the surgical wound is often extreme. For this reason, patients often lack the confidence to continue with respiratory therapy exercises and coughing following discharge.

There is a trend toward early discharge of open heart surgery patients.  The risk to these patients in the unsupervised, post discharge setting is two-fold: 1) the patient may be unaware or unable to diagnose a potential surgical wound complication (success in treating sternal wound complications depends upon early recognition and management);  and 2) due to pain considerations, patients often lack the confidence to continue their respiratory therapy exercises in the outpatient setting. Heart Hugger™ can help manage their pain by stabilizing and supporting their surgical wound.

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