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Effect of delayed sternal closure after cardiac surgery on respiratory function in ventilated infants
E Main1, M J Elliott, M Schindler
1Physiotherapy Department, Great Ormond Street Hospital for Children NHS Trust, London, UK.
Insights
Delayed sternal closure after infant heart surgery significantly reduces tidal volume and CO2 elimination. Increased ventilatory support is recommended to manage compromised respiratory function post-procedure.
Area of Science:
- Pediatric Cardiac Surgery
- Respiratory Physiology
- Intensive Care Medicine
Background:
- Limited evidence exists on respiratory function post-sternal closure.
- Ventilation management after delayed sternal closure requires further investigation.
Purpose of the Study:
- To assess the impact of delayed sternal closure on infant respiratory function.
- To evaluate changes in expired tidal volume, respiratory system compliance, and CO2 elimination.
Main Methods:
- Prospective study involving 17 infants undergoing open heart surgery.
- Continuous respiratory function monitoring before and after delayed sternal closure.
- Measurements included tidal volume, respiratory system compliance, and CO2 elimination.
Main Results:
- Expired tidal volume decreased by 17% and CO2 elimination by 29% post-closure.
- Respiratory system compliance decreased by 19% in infants with minimal air leak.
- Three infants required increased ventilation, and one needed pericardial fluid removal.
Conclusions:
- Delayed sternal closure compromises respiratory function in infants.
- Increased ventilatory support is crucial after delayed sternal closure.
- Monitoring blood gases and managing air leaks are vital for optimal patient care.
Objective:
Studies examining the effect of sternal closure on respiratory function have not been published, and currently there is little evidence to guide ventilation management immediately after closure. The aim of this study was to establish the impact of delayed sternal closure on expired tidal volume, respiratory system compliance, and CO2 elimination immediately after the procedure in infants who had undergone open heart surgery.
Design:
Prospective study of respiratory function before and after delayed sternal closure.
Setting:
Cardiac intensive care unit, Great Ormond Street Hospital, London.
Patients:
Seventeen infants (median age, 2 wks) with open median sternotomy incisions after cardiac surgery. Data were collected between August 1998 and March 2000.
Interventions:
Respiratory function was measured continuously for 30 mins before and after delayed sternal closure in paralyzed ventilated infants.
Measurements And Results:
Four babies were excluded from the study because they required either immediate increase in ventilation after delayed sternal closure (n = 3) or removal of pericardial blood collection (n = 1). In the remaining 13 infants, expired tidal volume and CO2 elimination decreased significantly (p < .005) by a mean of 17% and 29%, respectively, after sternal closure. In five of the remaining 13 patients, the magnitude of tracheal tube leak increased by > or = 10% after delayed sternal closure, thereby invalidating recorded changes in respiratory system compliance. Of the eight infants in whom there was a minimal change in leak, respiratory system compliance decreased significantly (p < .05) by a mean of 19%.
Conclusions:
This study supports the hypothesis that respiratory function may be compromised after delayed sternal closure and that ventilatory support should be increased to counteract the anticipated decrease in tidal volume. Extra vigilance should be applied in monitoring blood gases after delayed sternal closure to assess clinical responses to sternal closure or changes in ventilatory support. Accurate assessment of change in respiratory system compliance after any therapeutic intervention may be precluded by changes in tracheal tube leak during the procedure.