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Effect of median sternotomy on respiratory system compliance in humans: evaluation without sophisticated instrumentation

^a 2nd Critical Care Department, Athens University Medical School, ATTIKON University Hospital, Rimini 1, XAIDARI 12462, Athens, Greece
^b Department of Anesthesiology, Evangelismos Hospital, Athens, Greece
^c 1st Critical Care Department, Athens University Medical School, Evangelismos Hospital, Athens, Greece

*Corresponding author. Tel.: +30 210 5832186; fax: +30 210 5326414.

E-mail address: aarmag{at}med.uoa.gr (A. Armaganidis).

To evaluate the effect of median sternotomy on the static compliance of the respiratory system (C_RS) in humans, we used a new technique for pressure–volume (PV) curve tracing without sophisticated instrumentation. The accuracy and the reproducibility of the new technique were tested in a lung simulator, while its agreement with multiple-occlusion (MO) technique (the technique most often used in the ICU for C_RS measurement) was evaluated in 12 mechanically ventilated patients. Finally, the NCI technique was used in 13 cardiosurgical patients to measure C_RS before and after median sternotomy. Measurements provided by the NCI technique were at least as accurate as standard measurements in the bench study. In ICU patients, we observed a good agreement of C_RS measurements provided by the two techniques (bias 0.8, 95% limits of agreement –5.6 to 7.2 ml/cm H₂O) and a similar reproducibility. In cardiosurgical patients we observed a significant (P=0.037) increase in C_RS with an upward and leftward shift of the PV-curve after median sternotomy. No adverse effect was observed during PV-curve tracing maneuvers. The simplicity of NCI technique allowed for the first time, to our knowledge, PV-curve tracing in humans during cardiosurgery and revealed 5% increase in C_RS immediately after median sternotomy.

Key Words: Thoracopulmonary compliance; Pressure-volume curve; Median sternotomy; Cardiosurgery; Chest wall compliance