Bruno Matos

In our cabg's we just have a left atrium cath and a CVP cath, that we pull out in the morning after surgery. Almost of our patients stay at ICU just for 20 - 24 hours . We only put SG if we have a non linear pos op like dependency of vasoactive drugs, low urinary output, prolonged mechanical ventilation...

You always have a Swan Ganz catheter on your CABG patients ?

In my unit we use the following to know how much IV fluids we can give (cc/h): Required basic fluid = BSA x 1000 / 24 (post op day 0) ; post op day 1 : RBF = BSA x 1500 / 24 ... We have to pay attention to the other parameters like: Left ventricular function, creatinine, i & o balance, Right and left atria pressures...

Hi there! First of all - what kind of generators do you usually use? Single chamber or sequential pacing? Remember - if you have a ventricular pace you lose about 30% of CO (you lose the atrial systole) in a patient with poor ventricular function .... it's important! At the other hand, you can produce electrical stimuli but for many reasons they probably don't produce mechanical contraction (try to increase the mV output - avoiding phrenic stiumulation!) If after all the settings (output, sensing, rate) you can't increase the BP .... you have to assess the volemic status of the pt. and maybe his contractility it's not the best.... Hope this help. Bruno M

Someone have experience in management of recurrent SVT (more than 12 episodes/d) in a baby (1 month old) who underwent cardiac surgery ? Those episodes ceases with Adenosine bolus and actually the baby has amiodarone (cont) and propranolol Iv (q6h). Thanks.

We use to confirm all the preparation of the drug (total amount, dilutions, etc...) with 2 persons. And always be careful with the hipokalaemia, correct it before administration!! Side efects have much more probability to occur in presence of that.

I will love that!!! :chuckle Bruno.

Occasionally we use NO to ventilate our babies with PPH (in the post op of cardiac surgery). We don't have any protocol to manage these situations (like determination of metahaemoglobin ... ) We don't have also any devices to evaluate the contamination of air. Do you have any guidelines on this subject? Thanks.

We use cpap to, but in some cases, we need to know if the patient can be without any "help" pressure. And so, we put him with t piece no more than 15-30 min. Usually we do like this: VC - SIMV+PS (reducing progressively the RR and PS) - CPAP and sometimes T piece trial.

During the weaning period we usually use the t piece trial. In your protocol, how many liters of oxygen do you use at this stage, it depends of the PaO2 before ? Thanks for your help!

How do you evaluate the verbal response in the patients under mechanic ventilation. It´s a major doubt in my unit. Happy new year!

How can we explain the difference between the values of the pulse oximetry and the arterial saturation in the same child at the same moment? A lot of times we have a pulse oximetry of 85% with 98% on ABG. Thanks for your help.

Our ICU table it's a little bit old ... Someone knows where I cand find a really actualized table? Thank you for your help.