Major complications following thoracic surgery fall into two categories: respiratory complications and wound infections. Especially at risk are those patients with co-morbidities (e.g. diabetes, obesity, emphysema, COPD, etc.) as well as barrel-chested men, large breasted women and patients on the vent for a prolonged period.

Respiratory complications are a primary concern in the recovery of the post surgical patient. Stabilization and return to premorbid levels of respiratory function is a major determinant in the discharge of patients. The use of a sternum support harness provides your patients with the confidence and independence to be aggressive with respiratory therapy, keeping them on your clinical pathway. Following discharge, continuing respiratory therapy exercises are critical to full recovery.

Sternal wound infection increases length of hospitalization more consistently than any other major complicationⁱ and significantly influences readmission.ⁱⁱ Treatment of sternal wound complications requires a multidisciplinary approach for effective patient care.ⁱⁱⁱ Use of a sternum support harness to stabilize the sternal wound reduces both pulmonary and wound complications,^iv,v enhancing both quality of care and cost containment.

Providing your patients with Heart Hugger™ gives them the best possible chance at a speedy, uncomplicated recovery. Heart Hugger™ is the standard of care at more than 340 hospitals worldwide.

1. Weintraub, W.S., Jones, E. L., Craver, J., Guyton, R. et al(1989). Determinants of prolonged length of hospital stay after coronary bypass surgery. Circulation, 80, pp. 276-284.
2. Loop, F.D., Lytle, B.W., Cosgrove, D.M., et al(1990). Sternal wound complications after isolated coronary artery bypass grafting: Early and late mortality, morbidity, and cost of care. Annals of Thoracic Surgery, 49, pp. 179-187.
3. Vitello-Cicciu, J.(1989). Sternal wound management: a case study. Nursing grand rounds. Journal of Cardiovascular Nursing, 3(3), pp.66-70.
4. Ellertson, D., Zapolanski, A., Moloney, S.T. et al(1991). Management and Prevention of Post-Sternotomy Mediastinitis. San Francisco Heart Institute, Seton Medical Center, 1900 Sullivan Avenue, Daly City, California.
5. Teodori, Michael F., MD. In a letter dated August 7,1991. 340 East Palm Lane, Suite 330, Phoenix, Arizona 85004.

The most common respiratory complication is pulmonary collapse. During monotonous tidal ventilation, progressive alveolar atelectasis occurs until a deep breath is taken to apply sufficient pressure to reopen the collapsed alveoli. These deep breaths occur five to ten times hourly in normal resting adults.ⁱ

Normal lung compliance and alveolar aeration is abolished by general anesthesia, by narcotic drugs, such as morphine and by the effects of the ventilator, with the result that widespread alveolar collapse and fluid buildup is invariably present following surgery.^8,ii

Deep breathing exercises with emphasis on sustained inspiration to total lung capacity has been consistently effective in inflating alveoli and preventing postoperative pulmonary complications.^iii,iv Preoperative instruction includes the practice of proper deep breathing and coughing maneuvers.^v Unfortunately, recovering thoracic surgical patients are frequently non-compliant during their respiratory therapy exercises because of pain or fear of pain.

During a recent evaluation at a very busy Heart Hospital in Northern California a Respiratory Therapist informally measured the lung volume of his patient during deep breathing exercises while using a pillow and Heart Hugger™ alternately to splint the sternal wound. The result was nothing short of astounding.

He first recorded the lung volume levels while the patient used the incentive spirometer while splinting with the pillow. He then showed the patient how to use Heart Hugger™ and again measured lung volume. He recorded an increase of 30% in lung volume immediately.

The comfort, support and pain relief Heart Hugger™ offered the patient allowed him to be more aggressive with his deep breathing.

Heart Hugger™ can help increase the lung volume of your patients, getting them back to pre-op respiratory levels quicker, keeping them on your clinical pathway.

"Over half our patients are released by the fifth post-operative day, and many by the fourth post-operative day. I believe this is due in a large part to the fact that we have a device available which allows the patient to continue aggressive coughing and deep breathing at home, with much less discomfort."
David G. Ellertson, M.D., Thoracic and Cardiovascular Surgery, Modesto CA

"I am impressed that my patients who use Heart Hugger™ all seem to have a much smoother convalescence... Because of this speeded recovery; I am inclined to allow them to be discharged from the hospital earlier."
Michael F. Teodori, M.D., Pediatric and Adult Cardiovascular Surgery, Phoenix AZ

1. Bendixen, H., Bullwinkle, B., Hedley-Whyte, J. & Laver, M.(1964). Atelectasis and shunting during spontaneous ventilation in anaesthetized patients. Anaesthesiology, 24, pp. 297-301.
2. Hamilton, W., McDonald, J., Fisher, H. & Bettards, R.(1964). Postoperative respiratory complications. Anaesthesiology, 25, pp. 607-612.
3. Bartlett, R. Gazzaniga, A. & Geraghty, T.(1973). Respiratory maneuvers to prevent postoperative pulmonary complications: A critical review. Journal of the American Medical Association, 224, pp. 1017-1021.
4. Alexander, G., Schreiner, R. & Smiler, B.(1981). Maximal inspiratory volume and postoperative pulmonary complications. Surgery, Gynecology & Obstetrics, 152, pp. 601-603.
5. Sorenson, K. & Luckman, J.(1980). Medical-Surgical Nursing.

Sternal wound complications fall into three categories: 1) Deep Subcutaneous Infection, 2) Sternal Infection, and 3) Mediastinal Infection with Sternal Dehiscence.ⁱ

Mediastinitis can contribute to the development of life threatening illnesses, such as systemic sepsis, respiratory insufficiency, and renal failure. Mediastinitis occurs as a result of sternal instability and dehiscence⁵ and is usually evident from six days to three weeks following surgery.ⁱⁱ Most patients are usually discharged by this time. Patients at risk for mediastinitis and dehiscence include: patients older than 65 years (the Medicare population), diabetes patients, older women (osteoporosis), obese patients, COPD and those subjected to prolonged postoperative ventilation.^5,iii,iv

The incidence of morbidity and death from sternal wound complications occurs in significant numbers of patients. Upwards of 2.3% of patients may suffer these complications with an associated mortality rate of 13% to 52%.^3,v,vi The incidence of mortality after initial discharge and up to the first postoperative year is nearly as high as hospital mortality.³

1. Boyce, J.M., Potter-Bynoe, Dziobek, L.(1990). Hospital Reimbursement patterns among patients with surgical wound infections following open heart surgery. Infection Control and Hospital Epidemiology, 11(2), pp. 89-93.
2. Norris, S. O.(1989). Managing postoperative mediastinitis. Journal of Cardiovascular Nursing, 3, pp. 52-65.
3. Lazar, H.L., Wilcox, K., McCormick, J.R., et al(1987). Determinants of Discharge following Coronary Artery Bypass Graft Surgery. Chest, 92(5), pp. 800-802.
4. McDonald, W.S., Brame, M., Sharp, C. et al(1989). Risk factors for median sternotomy dehiscence in cardiac surgery. Southern Medical Journal, 82(11), pp. 1361-1364.
5. Ottino, G., Depaulis, R., Pansini, S. et al(1987). Major sternal wound infection after open-heart surgery: a multivariate analysis of risk factors in 2,579 consecutive operative procedures. Annals of Thoracic Surgery, 44, 173-179.
6. Sarr, M.G., Gott, V.L., Townsend, T.R.(1984). Mediastinal infection after cardiac surgery. Annals of Thoracic Surgery, 38, pp. 415-423.

Return to pre-morbid levels of respiratory function is a major determinant in the discharge of patients. Recovering open heart patients are frequently non-compliant during their respiratory therapy exercises because of pain or fear of pain. Recent federal studiesⁱ have shown that inadequately managed pain can inhibit recovery, prolong hospitalization and contribute to higher-than-necessary costs. The Wound Support and Pain Management provided by Heart Hugger™ helps keep patients on your clinical pathway.

The post discharge necessity of respiratory therapy exercises cannot be overemphasized. The use of Heart Hugger™ gives patients the confidence and independence to continue these exercises in the unsupervised post discharge setting.

In addition to a high mortality rate, wound complications can be financially devastating to the hospital, particularly the Medicare and co-morbid population. The cost to hospitals for complications and the resulting increased length of stay ranges from $13,453 to $109,118 per complication. (To see how much money your hospital’s heart program can save by using Heart Hugger™ click HERE).

1. Agency for Health Care Policy Research (1992). New Guidelines for Pain Relief After Surgery. AHCPR Publications Clearinghouse, P.O. Box 8547, Silver Spring, MD 20907

Aggressive coughing and deep breathing maneuvers, which frequently initiates coughing, are important for purging the lungs of fluid and inflating the lungs to prevent atelectasis. These maneuvers are initiated in the hospital and are a mandatory part of post discharge respiratory therapy.²¹ The percussive expansion associated with coughing puts extreme stress on the sternal wound. Ambulating, getting into and out of bed or chairs, bowel movements and other normal activities also place strain on the sternotomy site. While patients experience this stress on their sternal wound as pain and the feeling that they are "coming apart", the clinical result may in fact be grave: dehiscence and mediastinal infection.

Sternal stability is crucial in preventing these severe sternal wound complications. Until recently, prophylactic methods used to achieve sternal stability following a sternotomy has been available only to the extent that folded sheets, towels or a pillow could be used to "splint" the incision.¹² This method, while providing an inward pressure to the sternum, provides no encircling support to the rib cage and chest wall during coughing, is unavailable to the patient when ambulating, and provides no lateral support to stabilize the sternal wound.

Without sternal support, the pain of the surgical wound is often extreme. For this reason, patients often lack the confidence to continue with respiratory therapy exercises and coughing following discharge.

There is a trend toward early discharge of open heart surgery patients.^5,6,21 The risk to these patients in the unsupervised, post discharge setting is two-fold: 1) the patient may be unaware or unable to diagnose a potential sternal wound complication, (success in treating sternal wound complications depends upon early recognition and management¹⁵); and 2) due to pain considerations, patients often lack the confidence to continue their respiratory therapy exercises in the outpatient setting. Heart Hugger™ can help manage their pain by stabilizing and supporting their surgical wound.

1. Ellertson, D.G., MD. In a letter dated May 28, 1991. 1800 Coffee Road, Suite 101, Modesto, California 95355.

Heart Hugger™ Sternum Support Harness is a U.S. FDA classified medical device that provides a clear alternative to the limited methods previously described. It is a simple harness fitting over the shoulders, with a four inch wide belt around the chest, finished with handles on either end. The belt is adjusted to center the handles over the sternal wound, the patient's hand width apart. Squeezing the handles together with one or both hands tightens the chest belt, supporting the chest wall and stabilizing the sternal wound. Completely encircling the chest, it remains loose and passive until activated by the patient.

Patients are introduced to the device prior to surgery as a part of their preoperative education. Following surgery (usually upon transfer from ICU to step down) patients are fitted with the device over their gown. Following discharge, patients wear the device at home over their street clothes for approximately three to four weeks.^6,21,22 In this unsupervised setting it is essential that patients be able to stabilize their sternal wound for continuing respiratory therapy exercises and other stress resulting from the resumption of normal activities.

Used in conjunction with contemporary methods of wiring the sternum and suturing tissue layers, maximal sternal wound stability is achieved. The incidence of sternal infection is reduced and sternal dehiscence is practically eliminated.^5,6 Additionally, preoperative respiratory capacity levels are achieved sooner when the device is used in conjunction with respiratory therapy exercises.

After a short training period, patients operate the Heart Hugger™ themselves when they feel the need to stabilize their wound. It is a turning point in the patient's perception of recovery. It returns control to the patient. If patients feel that they have some control over the situation that affects them they will perceive the situation to be less stressful, will be less threatened, and will cooperate and perform better.^6,23 Patients experience more confidence and independence, taking control of their own recovery sooner, exemplifying the true sense of cardiac rehabilitation and keeping them on your clinical pathway.

There is a trend toward earlier discharge of thoracic surgical patients. The potential for respiratory complications, and particularly wound complications continues well into the discharge period.^3,6 Heart Hugger™ enables patients to stabilize their wound, continuing aggressive coughing and deep breathing exercises while resuming normal activities: walking, climbing stairs, getting into and out of automobiles, etc.

1. Vathayanon, Sathaporn, MD. In a letter dated May 21, 1991. 728 E. Bullard Avenue, Suite 104, Fresno, California 93710.
2. Huckabay, L., Daderian, A.D. (1990). Effect of choices on breathing exercises post open heart surgery. Dimensions of Critical Care Nursing, 9(4), pp. 190-201.