736 A COUGH-BELT TO PREVENT AND TREAT POSTOPERATIVE PULMONARY COMPLICATIONS IN the past, postoperative chest troubles have commonly been attributed t...

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A COUGH-BELT TO PREVENT AND TREAT POSTOPERATIVE PULMONARY COMPLICATIONS IN the past, postoperative chest troubles have commonly been attributed to the anxsthetic. But anaesthesia, by whatever means, has little or no influence upon their incidence. The chief cause of chest complications is pain, resulting in inability to cough. Other causes are pre-existing lung or cardiac disease, especially where there has been inadequate preoperative physiotherapy ; and mechanical factors such as abdominal distension and phrenic paralysis or fractured ribs with consequent



Personal experience of difficulty in coughing after a major abdominal operation in 1950 and of the great help afforded by chest and wound support led directly to the design of a coughbelt. It helps to combat each of the predisposing causes. Apart from emergencies where little preoperative instruction is possible, patients are trained for two days before operation to clear their chests by coughing and breathing exercises with the cough-belt in position. When there are fractured ribs or other mechanical factors, they quickly recognise the stabilising value of the belt, immediately enhancing their ability to cough without pain. It is received equally gratefully by patients with painful medical lesions, such as pleurisy, and especially by the emphysematous. It enhances their ability to exhale because they have a support against which they can push out retained air. In most non-teaching hospitals physiotherapists are scarce. The cough-belt, so simple to explain to patients and so easy

Fig. I-The cough-belt.

for them

to use

unaided, is prov-

ing an encouragement to

the over-


physiotherapist. It has used extensively in one chest and two been

general hospitals where the writer works. Once patients understand its use and the relief it gives,

they refuse to give it up even for an hour. It allows them to

cough painlessly

Fig. 2-An elderly bronchitic patient, with a major abdominal wound, coughing freely supported by the cough-belt.

a sense of security, and their morale improves at once. They bring up sputum easily: their chests clear and their ribs are stabilised, greatly diminishing dyspnaea due to paradoxical respiration. Stay in hospital is reduced and fewer antibiotics


New Inventions

in the presence of major thoracic or abdominal wounds. It supports their

wounds, giving


necessary. The cough-belt is simple in design and application, and it will fit patients of almost all sizes (figs. 1 and 2). It consists of a leather or plastic belt, some 4 in. wide. It has plastic-covered metal loop handles at each end. The smaller handle slips easily through the larger. Each handle is gripped and pulled by the hands and there are ’Velcro ’ surfaces which adhere in any position or degree of tightness giving very firm support against the strongest cough. These surfaces can be stripped apart by merely pulling one end outwards. Initial instruction need take only a few minutes: one physiotherapist can cope with the postoperative chest difficulties of two busy surgical wards in a single morning. Soon the cough-belt becomes the patient’s friend and helper both day and night.

Cough-belts Lok’ and Sussex.


are manufactured under the trade obtainable from Hawksley & Sons,

Institute of Chest Diseases, London, S.W.1

of ’CoughLtd., of Lancing,





A LOW-EFFICIENCY DISPOSABLE HEAT EXCHANGER recent OVER years several heat exchangers have been control to developed the temperature of blood for use with circuits and for organ perfusion. The trend is extracorporeal towards units with smaller priming volumes and increased efficiency. This entails the construction of complex countercurrent deyices which can be dismantled for cleaning. Goodconducting inert materials are necessary-which normally means stainless steel. These carry the disadvantages of high cost and the necessity for a fine degree of control in the heatexchanger supply system. The use of thin-walled, small-bore plastic tubing to carry blood through a water-bath has the advantage of simplicity, both of assembly and of use. The coil may be immersed in ice and water or brine for cooling and in water up to 45 °C for rewarming, the extent of the heat exchange being proportional to the length of the tubing immersed and inversely proportional to the rate of flow. The low efficiency is therefore not a problem when flow-rates are low, and a stirrer in the water-bath increases the heat exchange. Problems in the use of this tubing have been related to its assembly, maximum flow-rates, and behaviour during sterilisation. If coiled around a former, the tubing flattens during autoclaving and the joints to wider tubing tend to become loose. If the tubing is left on the former, this interferes with the heat exchange. These problems have been avoided by using ordinary dripset tubing of 4 mm. bore and 0.75 mm. wall thickness, and solvent to stick it into a spiral and also to stick wider tubing to the ends. The spiral is self-supporting and will not kink; the diameter can be varied but 5 in. has been most convenient. This principle has now been applied in the Queen Elizabeth


Hospital three forms: 1.


16 ft.

length for cooling blood for continuouss coronary-artery

perfusion and rewarming the heart. This will accept a flowrate of 700 ml. per minute without posing



sistance. 2. A 4-metre length for re-

warming blood