Early detection of patients at risk of sternal complications is essential to facilitate prevention and optimize timely intervention. A systematic review and meta-analysis was conducted to identify ...risk factors associated with sternal complications. The review included 17 full-text studies, of which 10 were entered into meta-analyses. Female gender, diabetes mellitus, obesity, bilateral internal mammary artery grafts, reoperation for postoperative complications, and blood product requirement were reported as significant predictors of sternal infection. The compilation of these risk factors may help to screen and stratify patients at risk of impaired sternal healing and warrants further investigation.
Abstract Purpose This study aimed to (1) document patterns of quadriceps muscle wasting in the first 10 days of admission and (2) determine the relationship between muscle ultrasonography and ...volitional measures. Materials and methods Twenty-two adults ventilated for more than 48 hours were included. Sequential quadriceps ultrasound images were obtained over the first 10 days and at awakening and intensive care unit (ICU) discharge. Muscle strength and function were assessed at awakening and ICU discharge. Results A total of 416 images were analyzed. There was a 30% reduction in vastus intermedius (VI) thickness, rectus femoris (RF) thickness, and cross-sectional area within 10 days of admission. Muscle echogenicity scores increased for both RF and VI muscles by + 12.7% and + 25.5%, respectively (suggesting deterioration in muscle quality). There was a strong association between function and VI thickness ( r = 0.82) and echogenicity ( r = − 0.77). There was a moderate association between function and RF cross-sectional area ( r = 0.71). Conclusions Muscle wasting occurs rapidly in the ICU setting. Ultrasonography is a useful surrogate measure for identifying future impairment. Vastus intermedius may be an important muscle to monitor in the future because it demonstrated the greatest change in muscle quality and had the strongest relationship to volitional measures.
Abstract Purpose The purpose was to determine ( a ) safety and feasibility of functional electrical stimulation (FES)-cycling and ( b ) compare FES-cycling to case-matched controls in terms of ...functional recovery and delirium outcomes. Materials and methods Sixteen adult intensive care unit patients with sepsis ventilated for more than 48 hours and in the intensive care unit for at least 4 days were included. Eight subjects underwent FES-cycling in addition to usual care and were compared to 8 case-matched control individuals. Primary outcomes were safety and feasibility of FES-cycling. Secondary outcomes were Physical Function in Intensive Care Test scored on awakening, time to reach functional milestones, and incidence and duration of delirium. Results One minor adverse event was recorded. Sixty-nine out of total possible 95 FES sessions (73%) were completed. A visible or palpable contraction was present 80% of the time. There was an improvement in Physical Function in Intensive Care Test score of 3.9/10 points in the intervention cohort with faster recovery of functional milestones. There was also a shorter duration of delirium in the intervention cohort. Conclusions The delivery of FES-cycling is both safe and feasible. The preliminary findings suggest that FES-cycling may improve function and reduce delirium. Further research is required to confirm the findings of this study and evaluate the efficacy of FES-cycling.
Abstract El-Ansary D, Waddington G, Adams R. Control of separation in sternal instability by supportive devices: a comparison of an adjustable fastening brace, compression garment and sports tape. ...Objective To evaluate the effectiveness of 3 supportive devices in controlling sternal separation. Design A cross-sectional, randomized intervention study. Setting Participants were from the general community who were referred to the study by their cardiac surgeon or cardiologist. Participants Fifteen patients (12 men, 3 women) between 49 and 80 years of age with sternal instability after a median sternotomy. Interventions Not applicable. Main Outcome Measures Support from sports tape, a compression garment, and an adjustable fastening brace was assessed by an ultrasound-based measure of sternal separation contingent on movement and by self-report measures of comfort, pain, feeling of support, ease of upper-limb movement, and ease of breathing. Results For both sternal separation and self-report data, some support was better than no support, and a supportive device worn on the body was better than sports tape. Wearing an adjustable fastening brace was better than a compression garment and, compared with no support, closed the sternal gap by 20% or 2.7mm (95% confidence interval, 1.5–3.9mm). The effects of wearing the different supportive devices on visual analog scale ratings of comfort, pain, support, ease of breathing, and movement mirrored the results obtained for sternal separation, thus providing agreement between self-report and objective measures. Conclusions Supportive devices may be useful in the management of patients with sternal instability because wearing one resulted in a reduction of both sternal separation and pain report after movement. The largest effect was obtained from wearing an adjustable fastening brace.
Purpose Sternal instability, a complication arising for some patients after sternotomy for cardiac surgery affects their later quality of life and cost of care. However, there are currently few ...guidelines for its diagnosis, quantification, and monitoring. Ultrasound equipment with associated software for calculating selected video-monitor distances provides one way of quantifying the extent of sternal separation. Description This study evaluated the validity and reliability of an ultrasound measurement made by attaching the head of the unit to an extensible stand. First the procedure was tested with bony sterna, and second in the examination of the chests of 8 patients with sternal instability. Evaluation Reliability estimation of the ultrasound measure on bony sterna gave ICC (2, 1) values >0.99, and reliability estimates for the sternal separation measure in the patient group were ICC (2, 1) values between 0.90 and 0.93. Conclusions Therefore gap measurements taken by ultrasound can objectively reflect the extent of bony separation occurring in a group of cardiac surgery patients experiencing sternal instability.
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