Ventilaion post CABG

[cloggs]

Hi Everyone. I am from the U.K. and wondered what ventilation modes are used on patients post CABG in your units. Having previously worked in general ICU where pressure modes dominated I am finding it unusal that most anethetists use volume. Little regard is given to high tidal volmes. Any feedback appreciated.

[sicushells, RN]

Usually our patients are on Continuous Mandition Ventilation immediately post-op. Tidal Volumes are based on patient's size. Peep is usually 5. We get an abg on arrival, and after the patient's reversed we get them ready for extubation. We try to extubate within 2 hours (doesn't always happen, and of course not in a patient who is unstable) hope that helps

[ALCCRN]

SIMV rate of 10-12, Tidal volume based on size (10cc per kilo), PEEP 5...Do you think they don't like high tidal volumes because of ARDS? A little early for that I know...just a thought...

[cloggs]

Thanks for feedback. My concern was the possibility of VILI if tidal volumes are high as current research seems to indicate considerable risk. We are advised to use 6-8mls per kg but often see higher tidal volumes.I acknowledge that most of our patients are ventilated for a few hours only but we also get long term vented- up to a year! Bipap on the Draegar vents just seems more appropriate than volume and the newer anethestists tend to use this mode. Guess I will just have to get used to the differences between general and cardiac icu.

[DMURSE1]

Hi Everyone. I am from the U.K. and wondered what ventilation modes are used on patients post CABG in your units. Having previously worked in general ICU where pressure modes dominated I am finding it unusal that most anethetists use volume. Little regard is given to high tidal volmes. Any feedback appreciated.

SIMV peep 10, PS 10 weight based Vt 5-8ml/kg

[joeyzstj, LPN]

SIMV is pretty well the standard of care in most facilities for post-op hearts. This primarily has to do with the difference in the mechinism behind how each mode ventilates. A/C can cause a cyclic buildup of intrathoracic pressure which can lead to compromised cardiac performance and in some cases, injury to the newly injured heart. SIMV allows for periods of pressure release once spontaneous breathing has been initiated. In the old days we used a Vt of 10 mls per KG of body weight. Newer guidelines recommend somewhere closer to 7. A lot of anesthesiologist still use higher volumes, whereas pulmonary critical care docs will use smaller volumes. Research supports the theory of the Pulmonologists.

[anurseuk]

We use volume controle SIMV, usually set volume around 500mls, although this is changed depending on the patients weight. And we also do ABG's pretty regularly to try to warm wake and wean quickly so will change vent settings based on them.

VT 500ml PEEP 5 PS 15 (reduced to 10 before extubation) rate 12.