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Samuel V. Lichtenstein
James G. Abel
Robert T. Miyagishima
Hilton Ling
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Ann Thorac Surg 1994;58:1734-1737
© 1994 The Society of Thoracic Surgeons

Articles

Effect of lung inflation and sternotomy direction on pleural space violation

Samuel V. Lichtenstein, MD, PhD*, James G. Abel, MD, Robert T. Miyagishima, MD, Hilton Ling, MD, C.Brian Warriner, MD, Moira E. Stilwell, MD, Christopher R. Thompson, MD

Divisions of Cardiovascular and Thoracic Surgery, Cardiology and Anaesthesia, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada

Accepted for publication June 9, 1994.

* Address reprint requests to Dr Lichtenstein, Division of Cardiovascular and Thoracic Surgery, St. Paul's Hospital, 1081 Burrard St, Vancouver, BC V6Z 1Y6, Canada.

Patients often are disconnected temporarily from the ventilator before sternotomy to avoid entering the pleural space with the sternal saw. Although this practice is widespread, it is based on questionable physiologic principles. To evaluate the efficacy of this maneuver in reducing the incidence of pleural space violation with first-time sternotomy, 126 cardiac patients were randomized prospectively to either lungs inflated or deflated during sternotomy with the surgeon blinded to the particular assignment. The incidence of pleural space violation overall was 12%, occurring in 15% of patients with deflated lungs and in 9% of those with inflated lungs (p = 0.455 by {chi} 2 test). Examining the effect of the direction of sternotomy on pleural space entry revealed a 4% incidence with sternotomy starting at the xiphoid versus a 21% incidence with sternotomy starting at the sternal notch (p = 0.009 by {chi} 2 test). Preexisting hyperinflation of the lungs as evaluated by chest radiograms did not influence the incidence of pleural space violation. To reduce pleural space violation, sternotomy should be performed from the xiphoid to the sternal notch. More importantly, disconnecting the patient from the ventilator does not reduce pleural space violation with sternotomy and its further use is not indicated. These findings are discussed in the context of relevant heart-lung patho-physiology.




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Home page
 Interact CardioVasc Thorac SurgHome page
A. Rostron and J. Dunning
Does deflating the lungs and sawing from the xiphisternum reduce the chance of accidental pleurotomy during sternotomy?
Interact CardioVasc Thorac Surg, June 1, 2005; 4(3): 272 - 274.
[Abstract] [Full Text] [PDF]


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