Ventilated patient requirements

All patients on ventilators require proper humidification of inspired gases. This is necessary to keep tracheobronchial secretions liquefied so that they can be removed.

All patients on ventilators require frequent percussion and vibration of their chest walls. This helps to eliminate thickened endobronchial and tracheal secretions.

All patients in their early postoperative course require frequent endotracheal suctioning to remove secretions accumulating in the tracheobronchial tree. We insist that our patients on ventilators undergo frequent turning and positioning so as to prevent hydrostatic pulmonary atelectatic changes.

Individuals who on clinical examination demonstrate bronchospastic airway findings should have added to their postoperative inhalation therapy treatment antibronchospastic agents such as Bronchosol, Aminophylline, etc.

Indications for Extubation

All patients who are to be extubated on our service should meet the following criteria.

1) They should be alert with an adequate cough and gag reflex. In addition, they must be able to lift their head off the pillow.

2) They must have an adequate cardiac, renal and nutritional status.

3) Their vital capacity must be between 10-15 cc/kg.

4) They must have a maximum inspiratory force more negative than -20 cm water.

5) Their alveolar arterial oxygen difference must be less than 350 mmHg.

6) Their pO2 on an FIO2 of 40% must be greater than 70 mmHg.

7) Their pCO2 should be between 35-45 mmHg.

8) The pH if their arterial blood must be between 7.38 and 7.45.

9) Their base deficit should be normal.

10) They should have no life threatening dysrhythmias.

11) Their mediastinal chest tube drainage should be minimum.

12) Their tracheobronchial secretions should be manageable.

13) Their chest radiograph should be satisfactory.

Post-Extubation Care

Ensure that after removing the endotracheal tube the patient is breathing comfortably without any evidence on physical examination of pulmonary, cardiac, or mental derangement.

Verify that the patient is doing well by obtaining an arterial blood gas 15-20 minutes after the tube has been removed.

Prevent gastric dilatation. Note all cardiac surgical patients will have a nasogastric tube in place on return from the operating room to prevent this phenomenon. In addition, the nasogastric tube should be maintained on a long term basis in individuals who have demonstrated the inability to tolerate food or liquids by mouth. Furthermore, patients who have a weakened or absent gag reflex should have prolonged nasogastric tube suction to prevent aspiration pneumonitis.

All patients should be continued on incentive spirometry until they leave the hospital.

Once the endotracheal tube is removed, a chest radiograph should be obtained. Note that all postoperative cardiac patients will have a chest x-ray done immediately upon arrival to the Intensive Care Unit and then every morning for the first 3 postoperative days.

Renal Care

Herbal Remedies For Acid Reflux

Herbal Remedies For Acid Reflux

Gastroesophageal reflux disease is the medical term for what we know as acid reflux. Acid reflux occurs when the stomach releases its liquid back into the esophagus, causing inflammation and damage to the esophageal lining. The regurgitated acid most often consists of a few compoundsbr acid, bile, and pepsin.

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