Consensus Guidelines of the Spanish Society of Cardio-vascular Infections
Guidelines of the Spanish Society of Cardiovascular Infections (SEICAV), the Spanish Society of Thoracic and Cardio-vascular Surgery (SECTCV) and the Biomedical Research Centre Network for Respiratory Diseases (CIBERES)
Three entities have joined forces to bring a diverse group of experts to the table, including anaesthesiologists, cardiac and cardiothoracic surgeons, clinical microbiologists, infectious diseases and intensive care specialists, internal medicine doctors, and radiologists.
The Posthorax Vest received a strong recommendation.
6.4. During the Postoperative Period
Is There Evidence That Sternal Immobilisation Systems Reduce the Risk of Mediastinitis Compared to Conventional Bandages?
We recommend the use of postoperative sternal immobilisation systems in all patients who undergo major cardiac surgery.
Evidence level 2+. Strong recommendation.
Postoperative sternal instability due to dehiscence or infection is a serious complication that may result in increased morbidity or hospital stay, the need for reintervention and greater cost. It may also increase mortality to as much as 25%.
In this scenario, it is important to establish preventive strategies and additional postoperative measures, including the use of thoracic immobilisation systems.
Prospective randomised studies have been conducted to assess the effectiveness of these immobilisation systems, as well as their ability to prevent sternal complications during the postoperative period after cardiac surgery.
The vest [175] consists of two longitudinal pads placed by compressing both sides of the sternum using a custom-made anterior and posterior stabilisation cerclage system to prevent intrinsic movement of the sternum boards during coughing, deep breathing, and night-time movement.
Its use is somewhat annoying and requires the collaboration of the patient. However, a randomised prospective multicentre study with over 1500 patients [176] concluded that the group of patients who used the vest had a lower cumulative rate of complications (0.61% vs. 3.87% p = 0.047), such as dehiscence (0% vs. 0.77%, p = 0.046), deep infection (0% vs. 1.99%) and superficial infection (0.6% vs. 1.1% p = 0.417).
In addition, hospitalisation time for complications was significantly shorter in the vest group (14.7 ± 707) compared to the control group (17.3 ± 17.5, p = 0.04).
These findings have been validated in two randomised prospective multicentre studies, in which routine use of the vest implied significant prevention of sternal dehiscence and decreased the relative risk of complications from deep infection [177,178].
Referenz: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8658224/
