Protective Ventilation And Lung Transplantation Surgery

When the organs fail the only option is a transplant. With lungs there is only a 50% rate of a five year survival rate after a lung transplantation involving the end-stage respiratory disease. With such a drastic survival rate a study was completed to determine if patients could have a better outcome. This study was done to help determine effective methods to enhance lung transplants before surgery; the Doctors placed the recipients on bi-level positive airway pressure ventilation (BIPAP.) “BIPAP is a noninvasive mode of ventilation administered through a tight-fitting mask to assist spontaneously breathing patients”

Even though the consequence of saline instillation on a ventilator patient in the acute care setting is pneumonia or the patient may become hemodynamically unstable, this practice remain contentious, the practice of this procedure will also decrease the oxygenation. (Ayhan, et al., 2015),

Patient outcome consisted of performing 10 deep breaths per hour. We have reviewed details that were difficult for the patient to remember, such as breathing out before placing the lips on the mouthpiece, and holding breath for 3 to 5 seconds at the top of each inhalation. With empathy, I provided understanding that being hospitalized is never easy due to sensory overload, pain and lack of privacy. Additionally, we have discussed the basic pathophysiology of lung inflammation and what it can do to a person. So overall, the outcome included enhanced disease knowledge with effective use of incentive spirometer.

From investigation in health practices, ventilator associated pneumonia caught my attention. “Ventilator Associated Pneumonia (VAP) is a leading cause of morbidity and mortality in intensive care units. Most episodes of VAP are thought to develop from the aspiration of oropharyngeal secretions containing potentially pathogenic organisms. Aspiration of gastric secretions may also contribute, though likely a lesser degree. Tracheal intubation interrupts the body’s anatomic and physiologic defenses against aspiration, making mechanical ventilation a major risk for Ventilator Associated Pneumonia. Semi-recumbent positioning of mechanically ventilated patients may help reduce the incidence of gastroesophageal reflux and lead to a decreased incidence of VAP. The one randomized trial to date of semi- recumbent positioning shows it to be an effective method of reducing VAP. Immobility in critically ill patients leads to atelectasis and decreased clearance of bronchopulmonary secretions. The accumulation of contaminated oropharyngeal secretions above the endotracheal tube cuff may contribute to the risk of aspiration. Removing these

You gave great examples of patient safety indicators that you saw in your clinical facility. It is interesting to see how different clinical sites handle certain preventative measures. “The purpose of patient safety measurement is to discover, assess, and correct problem areas before a significant untoward patient incident occurs.” (Spath, 2011, p. 60). Using a incentive spirometer and flutter valve are just a few ways that the nurses helped to prevent postoperative respiratory failure in patients you saw. They knew exactly what to do to help keep the patients lungs clear so that they would not end up with repercussions from their surgery. The steps that the nurses and facility choose will influence the unit’s practice and patient outcomes

Any person that is undergoing either a thoracic or abdominal surgery is at risk for developing pulmonary complications following surgery. Some factors can greatly increase the likelihood of post-operative pulmonary complications such as being overweight, smoking, age, bed-rest, general anesthesia, the use of muscle relaxers or analgesics and preexisting lung conditions. (Pusey-Reid). However, even a healthy young individual is at risk following surgery as well, if not taking the necessary measures to ensure adequate healing.

While the donor lung is being prepared and removed from its cold ice gauze (a technique to extend the cold preservation time), the pulmonary vessels within the thorax are clamped off. When considering order of re-anastomosis and insertion of the donor lung, bronchial arteries are reattached first, followed by the pulmonary artery, then the pulmonary veins.2 Before the final sutures are tightened, the donor lungs are inflated and aerated. The final steps of the procedure include a bronchoscopy, which examines the airways and detects any unwanted blood or secretions. However, bronchoscopies should be done sparingly as their uses may cause a delayed pneumothorax in a lung transplant patient.3

“Ventilator -associated pneumonias are the leading cause of death for patients diagnosed with hospital acquired infections” (Sadeghi, Barzi, Mikhail, & Shabot, 2013, p. 223). Pneumonia rates are higher in mechanically ventilated patients because the artificial airway increases the opportunity for aspiration and colonization. The rate of VAP increases for patients ventilated more than three days resulting in length of stay in ICU and LOS after discharge from ICU (Sedwick, Lance-0Smith, Reeder, & Nardi, 2012).

A simultaneously published trial called Oscar did not seem to have the same outcomes for patients receiving HFOV. There were multiple differences between Oscillate and Oscar, the most obvious being the use of the Novalung R100 in the Oscar trial. This was a new ventilator to the clinicians and hospitals participating in Oscar therefore, all clinicians participating in the study were required to go through 198 training classes to learn the specifics of the Novalung R100 ventilator. The outcome of the Oscar trial was only a 2 percent difference in mortality between conventional ventilation using a lung protective mode versus HFOV. This trial also had a similar outcome with vasoactive and neuromuscular blocking medications, Young et al states that this increase is due to the Novalung R100 not allowing for a patient to spontaneously breath on top of the oscillatory mode, therefore these medications were required to aide in patient- ventilator synchrony (Young,

Our patient was admitted to the ICU with respiratory distress. Respiratory distress is caused by an inflammation due to neutrophil activation. The body has an inability to transfer oxygen or carbon dioxide. This leads to increased permeability of A-C membrane, which then causes edema. Because of the edema, there is an increase in fluid in the peripheral areas and edema in hands, feet, and the scrotum. Decreased gas exchange also occurs because of the edema and mechanical ventilation is then implemented. The ventilator settings for our patient were: Rate 15, Peep 12, Peak Flow 60, FiO2 95, Flow Trig 1. Respiratory distress can also lead to multi organ failure if not treated; however, our patient’s respiratory distress resulted in

Effect of a Protective-Ventilation Strategy on Mortality in the Acute Respiratory Distress Syndrome (Amato et al.,). The topic of the article is the use of protective lung strategies and the effects they have on mortality rate for patients with Acute Respiratory Distress Syndrome (ARDS). The problem the authors, and practitioners around the world, face is that traditional methods for mechanical ventilation damage already diseased lungs which increases the mortality rate of patients with ARDS. The purpose of this study is to define what lung protective strategies are comprised of and to determine if using these strategies will reduce pulmonary complications which will ultimately decrease mortality rates. The questions the authors focused on were:

One lung ventilation (OLV) or lung isolation is a common term used in the practice of thoracic anesthesia. OLV refers to ventilation of one lung, while the other one is intentionally collapsed; thus, allows adequate surgical access for the surgeons (1- 6). Some indications for OLV are bronchopleural fistula, lung resection, single-lung transplantation, esophageal surgery, and open-chest aneurysm repair (3, 6). OLV can be accomplished by diverse techniques, two of which are either by using Double Lumen Tube (DLT) or Univent tube (3, 6- 10). the complications of using these tubes are vocal cord injuries, postoperative hoarseness, and sore throat (11). This dissertation will compare between the two tubes in terms of effectiveness in adult thoracic surgery.

Insufficient respiratory drive is common for post anesthesia patients. Patients are often given narcotics for pain which is a central nervous system depressant. The patient’s tongue may also fall to the back of their throat. There is also a risk for aspiration as secretions or vomit may be present in the airway and the patient will likely have a weak cough following sedation and intubation. The third major risk of respiratory compromise is atelectasis. This is caused by alveolar collapse. The alveoli are held open by surfactant and pressure in the form

Inverse ratio ventilation and Airway pressure release ventilation were also looked at in this study and they found only a short term benefit to patients with ARDS and was not recommended due to lack of trials with these modes showing an improvement in mortality.1

Support by noninvasive ventilation may be effective in mild cases of ARDS. Thus, majority patients require intubation and conventional ventilation. Mechanical ventilation is the key measure to maintain respiratory function until recovery of lung damage. The current ventilatory strategy is based on two concepts: lung protective strategy using a low tidal volume and open lung concept using high grades of PEEP.