SATS 2009 Final Program - Scandinavian Association for Thoracic ...

S18
PHYSIOTHERAPISTS ORAL ABSTRACT SESSION
S18:1
PRECAUTIONS AFTER MIDLINE STERNOTOMY. ARE THEY NECESSARY?
Brocki Barbara Cristina 1 , Thorup Charlotte Brun 1 , Skindbjerg Hanne 1 , Svalgaard Marianne 1 , Andreasen Jan Jesper 1
1) Aarhus Univers. Hosp, Denmark
Background
Patients after midline sternotomy are instructed on activity precautions to avoid sternal wound complications. We
question how restrictive those precautions must be, since they can lead to a decrease in quality of life in the
postoperative period.
Aims
To identify mechanical stress factors causing sternal instability and infection in order to draw up evidence based
guidelines for activity after sternotomy.
Methods
Literature review (CINAHL, Pub Med, Cochrane Library and PEDRO) and crosschecking references.
Results
Mechanical stress factors acting upon the sternum and the overlying skin are: constant coughing, BMI ≥ 35, skin
stress due to macromastia, excessive bilateral arm movements leading to skin breakdown, and loaded activity with
long lever arm. Our recommendations for precautions after midline sternotomy are: avoid stretching both arms
backwards at the same time for 10 days; use leg rolling with counterweighting when getting in and out of bed; only
move arms within pain free range; protect sternum when coughing by crossing the arms in a “self hugging” posture;
use supportive sternal vest when coughing constantly or when BMI ≥ 35, use supportive bra when breast cup ≥D;
loaded activity should be done with the elbows close to the body for 6 to 8 weeks.
Conclusion
Cough is considered the most important single mechanical stress factor causing instability. We found no evidence to
support weight limitation regarding activity, as long as the upper arms are kept close to the body, and activity within
pain free range.
S18:2
A RANDOMIZED CONTROLLED TRIAL ON DEEP BREATHING EXERCISES WITH POSITIVE
EXPIRATORY PRESSURE AFTER CARDIAC SURGERY
Urell Charlotte 1 , Emtner Margareta 1 , Breidenskog Marie 1 , Westerdahl Elisabeth 1
1) Physiotherapy, Uppsala University Hospital, Sweden
Objectives
Deep breathing exercises with positive expiratory pressure (PEP) has been shown to be beneficial on oxygenation
after cardiac surgery, but there is no consensus about the optimal duration and frequency of the treatment. The
aim of this study was to investigate the oxygenation effect of deep breathing exercises with PEP, with two different
breathing rates, the first two days after cardiac surgery.
Methods
In a prospective, randomized study 131 patients over 18 years, who underwent cardiac surgery were randomized
in two groups: treatment group (TG) (n=63), 10 deep breaths x 3 in a PEP-device every hour awake the first two
postoperative days and control group (CG) (n=68) 10 deep breaths x 1 every hour awake the first two postoperative
days. The main outcome measures were arterial blood gases. Tests were performed the second postoperative day.
Result
Mean age was 68.5 years and 25% were women. TG had significantly higher arterial oxygen tension (PaO2 8.9 ±
1.7 kPa vs 8.1 ± 1.4 kPa p= 0.004) and arterial oxygen saturation (SaO2 92.7 ± 3.7 % vs 91.1 ± 3.8%, p= 0.016)
compared to the CG. Both groups had the same compliance to the breathing exercises.
Conclusion
A higher breathing rate resulted in an improved oxygenation and the groups had the same compliance to the exercises.
Therefore a higher breathing rate should be recommended the two first postoperative days after cardiac surgery.
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