Literature review:Precautions after Midline Sternotomy

Dear coleagues

I´m pleased to inform you that the results from our study on precautions after midline sternotomy are now avaiable on line ( se below)

I´m sending this mail to you as contact persons for each country, so you can forward to the other colleagues in your country who are part of our network.

The swedish guidelines for chestphysiotherapy after abdominal and thoracic surgery are avaiable as well :
http://www.sjukgymnastforbundet.se/profession/kvalitetsutv/Sidor/Kliniskariktlinjer.aspx



Med venlig hilsen

Barbara Brocki
Specialeansvarlig fysioterapeut
99 322988
http://uk.mc271.mail.yahoo.com/mc/compose?to=bcb@rn.dk

AALBORG SYGEHUS
Ergoterapi- og Fysioterapiafdelingen
Afsnit A
Hobrovej 18-22
9000 Aalborg
http://www.aalborgsygehus.rn.dk/

Eur J Cardiovasc Nurs. 2010 Jan 3. [Epub ahead of print]
Precautions related to midline sternotomy in cardiac surgery A review of mechanical stress factors leading to sternal complications.
Brocki BC, Thorup CB, Andreasen JJ.

Department of Cardiothoracic Surgery, Center for Cardiovascular Research, Aalborg Hospital, Aarhus University Hospital, Hobrovej, postboks 365, DK-9100 Aalborg, Denmark;

Department of Occupational Therapy and Physiotherapy, Aalborg Hospital, Aarhus University Hospital, Hobrovej, postboks 365, DK-9100 Aalborg, Denmark.

BACKGROUND: After midline sternotomy patients are instructed on activity precautions to avoid sternal wound complications. We questioned how restrictive these precautions must be, since they can lead to a postoperative decrease in quality of life.

AIMS: To identify mechanical stress factors causing sternal instability and infection in order to create evidence based guidelines for activity following sternotomy.

METHODS: Literature review.

RESULTS: No evidence was found to support weight limitation regarding activity, as long as the upper arms are kept close to the body and activity is within a pain-free range.

RECOMMENDATIONS: Avoid stretching both arms backwards at the same time (10days); loaded activities should be done with the elbows close to the body (eight weeks); only move arms within a pain-free range; use leg rolling with counterweighing when getting in and out of bed; when coughing cross the arms in a "self-hugging" posture; supportive bra or vest is recommended when breast cup>/=D, body mass index>/=35 or frequent cough.

CONCLUSION: This study provides insights into mechanical stress factors acting upon sternum and the overlying skin. Recommendations on activity precautions based on these finding have a patient supportive approach focusing on possibilities and not restrictions.

Copyright © 2009 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.
PMID: 20051323 [PubMed - as supplied by publisher]