I've had many patients with open chests, but only one with the retractor left in place. That patient's surgery was over 12 hr long...No bueno! I think he probably died a few times on the table. The hand off report was "when he dies, make sure we get our retractor back"; the O.R. team ran away quickly after dropping him off in ICU. Luckily they were wrong and the patient recovered! As to not turning: the surgeon writes orders to not turn the patients with open chests...3 days later after closure when we are finally allowed to turn them there's a pressure ulcer.