Providing Anesthesia For Lung Transplantation

-Use of indiscriminate sedatives, benzos, and opioid’s, especially in post-op patient who retains Co2, may suppress the ventilator drive and lead to respiratory failure

ICU patients suffer from a broad range of pathologies, requiring MV, sedation and use of multiples devices, which do not allow patients to protect their airway (Augustyn. 2007; Kollef. 2004).

Another important intervention was to maintain the head of the bed at 30-45 degrees and position L.M.’s left lung into a dependent position to improve ventilation and perfusion. L.M.’s O2 was decreased to 63 and her CO2 was increased to 50. According to the IHI, it is recommended to elevate the bed to 30- 45 degrees to improve ventilation. Patients that lay in the supine position have lower spontaneous tidal volumes on pressure support ventilation compared to those laying at more of an angle (Institute for Healthcare Improvement, 2012). In regards to positioning, when the least damaged portion of the lung is placed in a dependent position it receives preferential blood flow. This redistribution of blood flow helps match ventilation and perfusion, therefore, improving gas exchange (Lough, Stacy & Urden, 2010). Implementing these interventions combined with respiratory therapy, significantly improved the blood gas values for oxygen and carbon dioxide levels.

Both rapid, shallow breathing patterns and hypoventilation effect gas exchange. Arterial blood gases will be monitored and changes discussed with provider. Alteration in PaCO2 and PaO2 levels are signs of respiratory failure. Patient’s body position will be properly aligned for optimum respiratory excursion, this promotes lung expansion and improved air exchange. Patient will be suctioned as needed to clear secretions and maintain patent airways. The expected outcome is that the patient’s airway and gas exchange will be maintained as evidence by normal arterial blood gases (Herdman,

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”

Although when it happens, there can be a devastating impact on patients as well as to the multidisciplinary theatre team involved. Consequently, the DAS has produced a consensus set of guidelines for managing failed intubations in adult and paediatric patients, but there are as yet no such nationally-agreed guidelines in obstetrics, therefore each obstetric unit should have their own flowchart with regards to management of failed intubation (Brien and Conlon, 2013). Furthermore, in light of the latest DAS guidelines, several aspects of clinical anaesthetic practise have changed over recent years (Frerk at al, 2015). Amongst the changes are the use of new drugs such as rocuronium and suggamadex and using electronic video-laryngoscopes (Frerk et al, 2015). Further work had also looked at extending the period of apnoea without causing desaturation by optimising the preoxygenation process and adequate patient positioning (Frerk et al, 2015). As a result, updated guidelines for difficult intubations in adult patients were published in 2015; these guidelines provide a flowchart to be used when endotracheal intubation proves difficult or impossible and focus on the central importance of oxygenation while reducing the amount of airway interventions in order to minimize trauma to the delicate airway (Frerk et al, 2015). The main message of the revised guidelines is

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.

38. American Journal of Respiratory care and critical care Medicine, Volume 175, issue 7, pages 698 – 704

Respiratory therapy refers to both a subject area within clinical medicine and to a distinct health care profession. During the 20th century, there were many health care fundamental transformations. Here are 10 possible predictions of what may occur in the future of respiratory care: (1) Less focus on raising PaO2 as a primary goal in managing patients with acute hypoxemic respiratory failure. (2) More attention to

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

J Mann, 160 post-operative respiratory complications were found in 144 patients. All the patients received gas, oxygen and anaesthetic (Mann, 1949) It also suggests respiratory problems rise abruptly in males over the age of 40. Mr Street is 69 years old. Patients are at risk of the following post-surgery loss of lung volume, CR conditioning, pain on deep breathing, pain on coughing, infection which can also be related to stress and weight loss, DVT, atelectasis, low oxygen saturation, reduced thoracic expansion, low mood, loss of mobility due to obesity which can result in reduced joint range and muscle strength, anxiety (secondary to his diagnosis of a potentially life limiting

For the past 50 years acute respiratory distress syndrome or better known as ARDS, has been an issue in hospital intensive care units all around the world. The first “documented published scientific description dates back to 1821 when Laennec described the gross pathology of the heart and lungs and described idiopathic anasarca of the lungs; pulmonary edema without heart failure in a treatise on diseases of the chest.”1 Cardiac and non-cardiac issues were not taken into consideration as part of the cause at that time. The first definition dates back to Ashbaugh and colleagues in 1967.2 Though modern medicine has been around for hundreds of years, it wasn’t until hospitals designed intensive care units and began using mechanical ventilation

The studies done on the subject of NSI for suctioning of ventilated patients have not provided a valid and solid conclusion. Nonetheless, most studies agree that NSI is not a recommended procedure when suctioning the ventilated patient. Factors that affect the decision include that the use of NSI provokes a higher incidence of VAP, hypoxemia, bronchospasm, cardiac and respiratory arrest, increased intracranial pressure, and no increase in the retrieval of mucus from the patient’s airway. Hence, the use of NSI should not be part of routine care when taking care of a ventilated

Liver transplantation (LT) is a well-established curative therapy for irreversible chronic end-stage liver disease or acute liver failure. Since the introduction of the liver transplant procedure, it has been a standard approach to give postoperative ventilation in children and exact timing of extubation is usually debatable, but it has been noted that early or even immediate extubation may be a feasible approach nowadays (1-3). It is important to assess the timing of extubation because premature discontinuation can be associated with respiratory complications such as airway obstruction, aspiration of tracheal secretions leading to pneumonia (4) and prolonged ventilation can lead to complications like endobronchial intubation, post-intubation stridor, endotracheal tube blockage, pulmonary air leak, bronchopulmonary dysplasia, pulmonary atelectasis (5). Therefore, identifying variables that can predict readiness for extubation will help us decrease morbidity and complications related to mechanical ventilation and also provide safe and quality care for this patient population. This study focuses on identification of the risk factors for delayed extubation and it is anticipated that variables such as age, preoperative weight, preoperative hemoglobin, the volume of blood products transfused and pH after induction can cause delayed