title: Changes in cardiac pumping efficiency and intra-thoracic organ volume during negative pressure wound therapy of sternotomy wounds, assessment using magnetic resonance imaging.
abstract: Knowledge on the effects of negative pressure wound therapy (NPWT) on the intra-thoracic organs is limited. The present study was performed to investigate the effects of NPWT on the volume of the intra-thoracic organs, using magnetic resonance imaging (MRI), in a porcine sternotomy wound model. Six pigs underwent median sternotomy followed by NPWT at -75, -125 and -175 mmHg. Six pigs were not sternotomised. MR images covering the thorax and heart were acquired. The volumes of the thoracic cavity, lungs, wound fluid and heart were then determined. The volumes of the thoracic cavity and intra-thoracic organs increased after sternotomy and decreased upon NPWT application. The total heart volume variation, which is inversely related to cardiac pumping efficiency, was higher after sternotomy and decreased during NPWT. NPWT did not result in the evacuation of wound fluid from the bottom of the wound. NPWT largely closes and restores the thoracic cavity. Cardiac pumping efficiency returns to pre-sternotomy levels during NPWT. This may contribute to the clinical benefits of NPWT over open-chest care, including the stabilizing effects and the reduced need for mechanical ventilation.
authors.affiliation: Department of Ophthalmology, Lund University Hospital, Lund, Sweden.
authors.forename: Christian
authors.initials: C
authors.lastname: Torbrand
authors.forename: Martin
authors.initials: M
authors.lastname: Ugander
authors.forename: Henrik
authors.initials: H
authors.lastname: Engblom
authors.forename: Göran K
authors.initials: GK
authors.lastname: Olivecrona
authors.forename: Olof
authors.initials: O
authors.lastname: Gålne
authors.forename: Håkan
authors.initials: H
authors.lastname: Arheden
authors.forename: Richard
authors.initials: R
authors.lastname: Ingemansson
authors.forename: Malin
authors.initials: M
authors.lastname: Malmsjö
mesh_terms: D000818:Animals; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002306:Cardiac Volume / Q000502:physiology*; D004195:Disease Models, Animal; D005122:Exudates and Transudates; D005260:Female; D008176:Lung Volume Measurements; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008480:Mediastinitis / Q000209:etiology / Q000628:therapy*; D009200:Myocardial Contraction / Q000502:physiology*; D054843:Negative-Pressure Wound Therapy / Q000009:adverse effects / Q000379:methods; D009929:Organ Size; D011182:Postoperative Care / Q000379:methods; D017592:Skin Care / Q000379:methods; D018709:Statistics, Nonparametric; D056346:Sternotomy / Q000009:adverse effects; D013552:Swine; D035423:Thoracic Cavity / Q000033:anatomy & histology / Q000601:surgery