chf and ventilator understanding

missnurse01, MSN, RN · Nov 18, 2012

It depends why they went on the vent in the first place. Was it all just vol overload ? Were they able to pull a lot of fluid off ? Are they at they normal wt ? We are usually able to extubate after pulling fluid off and optimizing cardiac function. Do them need a vad or transplant ? Not enough info ....so not sure what to say

blucrna · Nov 20, 2012

I agree. More info would definitely help answer the question. If its overload related a few days on a lasix or bumex may due the trick to alleviate that sob but if its ejection fraction related then it may take inotrops or vads

So could the patient be weaned off the vent.. sure. Will they be able to sustain their airway capacity after.... depends

Esme12, ASN, BSN, RN · Nov 20, 2012

I agree with blucrna.....We need more information to answer the question.

Biffbradford · Nov 21, 2012

Can someone with end stage chf be taken off the ventilator? If pt was intubated due to sob/chf then is it very unlikely that their heart won't be able to pump effectively without the vent?

^^^ Agreed.

Also, is there a smoking history? COPD? Or perhaps they have been sick so long that they just tired out and needed to be intubated? I don't think we can really answer this question in general.

Yes, people with 15% ejection fraction can breathe without vents, if that helps.

RNerd81 · Dec 2, 2012

One other thing I might mention...a patient with CHF may breathe better without the ventilator. This is jumping way ahead (because I'm assuming that pulmonary edema is resolved), but being placed on mechanical ventilation reverses the normal mechanisms of breathing and the "intrathoracic pump" is rendered ineffective. This is particularly problematic for patients with right-sided failure who need the preload that the intrathoracic pump provides. Beyond this statement, I agree with the others who have posted that more information is needed. Being off of the sedating medications that are usually used during mechanical ventilation would also benefit the person's hemodynamic profile.

Guest343211 · Dec 4, 2012

Well, as the others have said, it really depends on what you are doing and why. You could give a 100% FI02 by positive pressure, but if the person's heart is unable to pump effectively, pulmonary edema will ensue. The patient will drown in fluid, no matter how much oxygen you push in by pressure. So even if ventilated, you have to get the fluid out and optimize cardiac output function. That could involve any number of gtts, medications, and even devices of assist.

The point of intubating and oxygenating through PPV is to protect the patient's airway as well as optimize oxygentation--but the big caveat still remains, you have to address what is causing the back up of fluid--either with lasix or other IV diuretics, inotropes, afterload reduction, or some combination of these. MS04 Iv helps too--b/c of anxiety and also because there is a little bit of coronary vasodilation. So, it helps to know the cause of the failure in order to most effectively treat it.