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1998, Number 2

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Med Crit 1998; 12 (2)

Non invasive assessment of cardiac output of critically ill patients

Zetina THJ, Rentería AMC, Bonilla RLC

Language: Spanish
References: 21
Page: 49-53
PDF size: 130.71 Kb.


ABSTRACT

Objective. To evaluate the efficacy of an algorithm for the early extubation of patients underwent to cardio-pulmonary bypass.
Design. Prospective clinical study.
Setting. A cardiac Surgery Intensive Care Unit of Mexico City.
Patients. Thirty patients (mean age 53.3 ± years) underwent to cardicac surgery were enrrolled in the study. The endotracheal extubation of the patients was made on the basis of respiratory and neuromuscular function and pulmonary gas exchange (chest radiographies, pulse oximetry, PaO2 and PaO2 / FIO2). We registred the intubation time after the arrival of the patients to the ICU, ICU stay and mortality and morbidity.
Interventions. Endotracheal extubation.
Measurements and main results. We extubated success- fuly thirty patients in 274 ± 56.8 minutes after admission to the ICU. ICU stay was 46.1 ± 14.1 hours and the morbidity and mortality were 0%.
Conclusion. Early extubation after cardiac surgery is safe if a protocol based on respiratory and neuromuscular function and pulmonary gas exchange was used.


REFERENCES

  1. Lichtenthal P, Wade L, Niemyski P, Shapiro B. Respiratory management after cardiac surgery with inhalation anesthesia. Crit Care Med 1983;11:603-605.

  2. Gall S, Olsen C, Reves J et al. Beneficial effects of endotracheal extubacion on ventricular performance. J Thorac Cardiovasc Surg 1988;95:819-827.

  3. Walker W, Kapelanski D, Weiland A et al. Patterns of infection and mortality in thoracic trauma. Ann Surg 1985; 201:752-757.

  4. Ker G, Thomas S. Ventilatory management. In: De Williams J, editor. Postoperative management of the cardiac surgery patient, 1st ed. New York: Churchill Livingstone; 1996.p.99-122.

  5. Yang K, Tobin M. A prospective study of indexes predictiong the outcome of trials of weaning from mechanical ventilation. N Engl J Med 1991;324:1445-50.

  6. Tobin M, Guenther S, Pérez W et al. Konno-Mead analysis of ribcage-abdominal motion during successful and unsuccessful trials of weaning from mechanical ventilation. Am Rev Respir Dis 1987;135:1320-1328.

  7. Brenton C, Keddie R, Hakenewerth M, Thomason M. Unplanned extubation in a trauma intensive care unit. Crit Care Med 1994;22:A-34.

  8. Tindol A, DiBeneddetto J, Kosciuck L. Unplanned extubation. Chest 1994;105:1804-1807.

  9. Listello D, Sessler C. Unplanned extubacion. Clinical predictors for reintubation. Chest 1994;105:1496-1503.

  10. Buttler J, Chong G, Pillai R, Weaaby S, Rocker G. Early extubation after coronary artery bypass surgery: effects on oxygen flux and haemodinamic variable. J Cardiovasc Surg 1992;33:276-280.

  11. Maddor MJ. Weaning parameters. Are they clinically useful? Chest 1992;102:1642-1643.

  12. Jabour E, Rabil D, Truwit J, Rochester D. Evaluation of a new weaning index based on ventilatory endurance and the efficiency of gas exchange. Am Rev Respir Dis 1991; 144: 531-537.

  13. Miniati M, Pistolesi M, Milne E, Giuntini C. Detection of lung edema. Crit Care Med 1987;15:1146-1155.

  14. Halligan M, Moore P, Richards K, Brodie J. The effects of cardiopulmonary bypass. The manual of clinical perfusion. Glendale Medical Corporation; 1997. p. 91-100.

  15. Parker J, Hernandez L, Peevy K. Mechanisms of ventilator-induced lung injury. Crit Care Med 1993; 21: 131-143.

  16. Corso P, Eager C. Postoperative care of the adult cardiac surgical heart. En: Shoemaker WC, Ayres SM, Grenvik A, Holbrok, editors. Textbook of Critical Care. 3th ed. Philadelhpia: WB Saunders; 1995. p. 604-617.

  17. Kollef M, Peller T, Knodel A, Cragun W. Delayed pleuropulmonary complications following coronary artery revascularization with the internal mammary artery. Chest 1988; 94:68-71.

  18. Tahvanainen J, Salmenpera M, Nikki P. Extubation criteria after weaning from intermittent mandatory ventilation and continuous positive airway pressure. Crit Care Med 1983;11:702-707.

  19. DeHaven B, Kirton O, Morgan J, Hart A, Shatz D, Civetta J. Breathing measurement reduces false-negative classification of tachypneic preextubation trial failures. Crit Care Med 1996;24:976-980.

  20. Asada S, Yamaguchi M. Fine structural change in the lung following cardiopulmonary bypass. Its relationship to early postoperative course. Chest 1971;59:478-483.

  21. Paulissian R, Salem R, Joseph N et al. Hemodynamic responses to endotracheal extubation after coronary bypass grafting. Anesth Analg 1991;73:10-15.




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