Term
| Benefits of early extubation |
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Definition
| improved preload, decreased hemodynami compromise, early d/c from ICU, early ambulation, prevent complications from vent, decreased neuro probems in elderly, decreased morbidity from heart and lungs issues |
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Term
| Predictors of prolonged mechanical ventilation |
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Definition
Increased age
renal failure
COPD
CABG with other procedures
Aortic cross clamp time
Aortic aneurysm
emergent
valve procedures
pre op stroke
ICU with IABP
redo w/in 24 hours with bleeding
EF<30%
4 or more units of blood
CPB > 77 minutes
Anesthesia impacts duration |
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Term
| Delays associated with CPB |
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Definition
| decreased surfactant, pulmonary emolism, interstitial fluid in lungs, RBC damage |
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Term
|
Definition
| ability to cough, minimal secretions, pulmonary mechanisms, cardiovascular reserve, hemodynamics stability, no bleeding, normal temp, neuro intact to maintain airway |
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Term
| Negative Inspiratory pressure |
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Definition
| ability to generate cough |
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Term
| Respiratory Acidosis Causes |
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Definition
Anything inhibiting sufficient RR - retaining CO2
Neuromuscularblocking agents - imparied resp muscle function
pulmonary disorders: Atelectasis, pneumonia, pneumothorax, pulmonary edema and embolism
Increased CO2 production: shivering, sepsis
Hypoventilation Secondary to: pain, sternal incision, residual anesthesia, awakening with inadequate analgesia and imparied resp mechanics, opioids side effects
User error: inappr. vent settings, hypoventilation during transer from OR |
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Term
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Definition
resp: dyspnea, distresss, shallow respirations
Neuro: HA, restless, confusion
CV: cyanosis, pupil pinpoint, superficial vessel dilated |
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Term
|
Definition
| Treat cause of hypoventilation |
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Term
| Respiratory Alkalosis Causes |
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Definition
Hyperventilation 2nd to fear, anxiety, pain
Increased O2 demand : fever, sepsis
Pulmonary disorders: Pneumonia, pulmonary edema, aspiration, asthma, emphysema, COPD
Medications: resp stimulants (albuterol), catecholamines, nicotine
User error in transfer; hyperventilating |
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Term
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Definition
Neuro: lightheaded, agitated, numb/tingling, confusion, blurred vision
CV: chest pain, ischemic changes on EKG
Dry mouth, twitches, weakness, seizures |
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Term
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Definition
| TX underlying cause of hyperventilation. monitor for resp muscle fatigue, and acute resp failure. May need temporary mech vent |
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Term
| Metabolic Acidosis causes |
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Definition
Hemodynamics: ddecreased CO, inadaquete perfusion, hypotension, hypovolemia, vasoconstriction
Physiologic: Sepsis, low CO, hypoperfusion, renal failure, regional ischemia, DKA, anaerobic metabolism
Meds: Metformin |
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Term
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Definition
Fatigue, dyspnea, nausea, vomiting, deep respitions (Kussmauls), accessory muscles, tachycardia, hypotension.
Lab: hyperkalemia, hyperphosphatemia, hyperurecemia, hypocalcemia. |
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Term
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Definition
Restore Tissue perfusion, thereby preventing further hypoxemia and hypoxia from developing. If renal fail is the cause, possible dialysis.
Bicarb replacement if severe enough |
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Term
| Metabolic Alkalosis causes |
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Definition
Bicarb greater than 26 and pH greater than 7.45
Loss of acids: NGT suctioning, excessive diuretics without K and Cl replacement, hypochloremia
Hypokalemia
Massive Transfusions |
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Term
|
Definition
Neuro: weakness, cardiac dysrhythmias, jittery
Musculoskeletal: electrolyte imbalances, muscle spasms |
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Term
|
Definition
Can be difficult
Acetazolamide is commonly given after cardiac surgery when excess diuretics are given, which promotes the excretion of Na, K+, Ph, Bicarb, and water. In severe cases, greater than 7.55, may give HCl IV, if they require rapid correction.
May also give ammonia chloride in sever cases, converts in liver to HCl. |
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Term
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Definition
% of CO that does not participate in gas exchange. THis blood passes through the lungs but not exposed to ventilated alveoli, and so it does not participate in gas exchange. This blood leaves the lungs in a desaturated state.
Commonly increased due to atelectasis
Increasing FiO2 will not help! Need to correct the underlying problem. |
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Term
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Definition
THe difference between the percentage of alveolar oxygen enterin the alveoli and the percentage of oxygen diffusing into arterial blood.
THe higher the A-a gradient, the more severe the problem with oxygen reaching the blood.
As lungs re-expand postop, the A-a gradient normalizes. |
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Term
|
Definition
| Hemodynamically stable, normothermic, no dysrhythmias, not shivering, CT <100 ml/hr, A&O x 4, follows commands, taking spontaneous breaths. ABG and lab values in normal range, or as close as possible |
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Term
| Postop Mechanical Weaning: Initial settings |
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Definition
NIP: -25
RR: <25
HR: <140
MV: 10 L/min
VC: 10-15 ml/kg
Cardiac Status: no ischemia, no pressors or low dose inotropes
Neuro Status: alert, responds to commands, cough and gag reflex, can protect airway, clear secretions, sustain head lift 5 seconds |
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Term
|
Definition
RR: >35
HR: >140
SBP: >180
agitation, diaphoresis, anxiety, apnea lasting longer than 25 seconds, mental changes, decrease in SpO2 less than 92%, ETCO2 greater than 55.
If these occur, the trial is stopped, the patient is restored to vent settings, and an ABG is obtained. |
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Term
| How often should you do SBT? |
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Definition
| Hourly until weaning is successful |
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Term
| What if ABGs are not good post extubation? |
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Definition
| With MD consult. put back on ventilator, reassess in 30-60 minutes. |
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Term
| Weaning from prolonged care |
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Definition
| Improvement of pulmonary mechanics is better predictor of success than improved gas exchange. |
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Term
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Definition
Prior to extubate: deflate cuff, assess for laryngeal edema, ask to speak.
Once extubated: humidified face mask deliver FiO2 10% higher than last vent setting. Titrate to SpO2 97-98%.
Will have decreased BS in lower lobes due to atelectasis. evaluate work of breathing, RR, accessory muscles. Use IS, ambulation, auscultation, chest physiotherapy to mobilize secretions. |
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Term
| reasons for extubation failure |
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Definition
older age
illness severity
prolonged intubation
continuous sedation
upper airway obstruction
inability to clear secretions
neuro impaired
insecure airway
hypoxemia |
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Term
| reasons for successful weaning |
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Definition
| UO greater than 500 ml/day, platelet >100/day, no inotrope supprt, GCS 15, bicarb 20 or higher, absence of lung disease |
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