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Rib cage mechanics after median sternotomy
T J Locke1, T L Griffiths, H Mould
1Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield.
Thorax
|June 1, 1990
Summary
Sternotomy significantly reduces lung volumes and impairs rib cage movement, leading to breathing difficulties. Uncoordinated chest wall motion, particularly the rib cage, is a key factor in post-sternotomy breathing problems.
Area of Science:
- Thoracic surgery
- Respiratory physiology
- Pulmonary function testing
Background:
- Median sternotomy, a common surgical approach, leads to significant reductions in lung volumes.
- The precise mechanisms underlying this post-sternotomy ventilatory defect remain unclear.
Purpose of the Study:
- To investigate the mechanisms behind lung volume reduction after sternotomy.
- To assess changes in chest wall motion and respiratory coordination post-sternotomy.
Main Methods:
- Magnetometers measured lung volumes and chest wall motion (rib cage and abdomen) in 16 men before and after coronary artery grafting.
- Coordination between airflow and chest wall motion was assessed in multiple planes.
Main Results:
- Lung volumes decreased post-sternotomy, more so in the supine position.
- Tidal volume and rib cage displacement significantly reduced one week after surgery, with partial recovery at three months.
- Uncoordinated rib cage motion with airflow was observed in most patients one week post-surgery, persisting in some at three months.
Conclusions:
- Reduced and uncoordinated rib cage expansion significantly contributes to the restrictive ventilatory defect following median sternotomy.
- Abdominal motion remained coordinated with airflow, suggesting a specific issue with rib cage mechanics.