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Cardiac/Vascular Surgery (Physical status classifications (III - Severe…
Cardiac/Vascular Surgery
Etiology
Acute or chronic cardiac/vascular disease or trauma
Pathophysiology
Associated with significant pulmonary complications even with healthy lungs
Clinical signs and symptoms
Diminished FRC indicates atelectasis
Reduced VC and impaired airway clearance lead to secretion retention and pneumonia
Obstructions can lead to V/Q mismatches and hypoxemia
Diagnostics
Incentive spirometry
PEP therapy
Physical status classifications
III - Severe systemic disturbance from cause with potential for postoperative complications
IV - Moribund with little chance of survival
II - Mild - to moderate systemic distubances
V - Emergency operations
I - local pathologic process with no systemic disturbance
Respiratory Management
Usually involves Intubation and MV
Full support (CMV/PCMV)
Vt 10 - 8 mL/Kg IBW
Rate set to provide PetCO2 between 30 - 40 mmHg
FiO2 to maintain SpO2 > 90%
PEEP 10 - 8 cmH2O
Extubation should ideally occur within 2 - 6 hours post surgery