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Cardiac/Vascular Surgery :<3: (Respiratory Management (Mechanical…
Cardiac/Vascular Surgery
:<3:
Etiology/Pathophysiology
Cardiac surgery is associated with significant pulmonary complications, even among patients with healthy lungs.
Typically a diminished postoperative FRC increases the likelihood of atelectasis, whereas the reduced vital capacity and impaired airway clearance due to pain and analgesia make the patient prone to secretion retention and pneumonia
Fluid imbalances and the general inflammatory response to surgery often increase capillary leakage and lung water, further aggravating V/Q inequalities and worsening hypoxemia
Clinical signs
and Symptoms
Atelectasis
Secretion retention
Decreased volume
Hypoxemia
Diagnostic Test/Assessment
and Info Gathering
After surgery: obtain a ABG, recommend a 5 lead ECG, Recommend hemodynamic monitoring, recommend post surgical chest Xray, recommend careful monitoring of fluid output, and recommend anti embolism stockings.
Recommend bedside spirometry for any patient wit a history of lung disease or smoking
Preoperative Education: to discuss airway and ventilator management, as well as training in the selected lung expansion and airway clearance methods.
Assess the patient preoperatively
Differential Diagnosis
Atelectasis
Pneumonia
Respiratory
Management
Mechanical ventilation
O2 therapy
Pulmonary hygiene/airway clearance therapy
Monitor closely for signs of worsening atelectasis or pneumonia
Lung expansion therapy
Initial vent settings; full support, VT 8-10 ML/KG, rate 12-20, Peep initially 8-10 cmh20
