| Autor: |
Maurer, William G., Kuntz, Rick A., Dillard, Richard E., Wilson, Louie C., Higgs, William R., Stone, John E., Maurer, William G., Kuntz, Rick A., Dillard, Richard E., Wilson, Louie C., Higgs, William R., Stone, John E. |
| Zdroj: |
Journal of Extra-Corporeal Technology; October 1981, Vol. 13 Issue: 5 p249-255, 7p |
| Abstrakt: |
Before consideration is given for discontinuing an assist device (IABP) a set protocol should be developed by the cardiac assist team through which the necessary steps can be taken for proper manage ment and control of the patient’s status. Such a protocol is described in this preliminary report. At our institution the feasibility of weaning is established via sequential clinical and hemodynamic assessments which are made prior to the initiation of the assist device and continue throughout the assist and weaning period. In the patient who is a candidate for cardiac surgery, an initial hemodynamic assessment is accomplished prior to surgery which serves as a baseline for future cardiopulmonary profiles and aids in the initial evaluation of the patent. The profile consists of various hemodynamic variables that are entered into the TRS-80 system which provides a printout of cardiac parameters used during trend analysis of the patient status. Counterpulsation is initiated as indicated by a compromised post-bypass profile or obvious left ventricular failure. Sequential hemodynamic and clinical reassessments are performed every 2 to 4 hours to aid the operator in making decisions as to the effectiveness of the assist as well as inotropic and/or vasopressor therapy. Typically 12-24 hours of assist are carried out prior to reassessment for discontinuation. Once optimal hemodynamic status is obtained the process of weaning begins consisting of 4 hours for each 24 hours of assist. The first phase of our weaning technique consists of Sec reductions to 50% of total balloon volume. In this way diastolic augmentation and afterload reduction are gradually tapered, thus minimizing significant increases in cardiac workload and acute strain. The second phase consists of an assist ratio reduction from every beat to every fourth beat which accounts for one-fourth the total wean time. Hemodynamic assessments of the patient’s condition are made before and shortly after each change in wean condition. Complete weaning and balloon catheter removal occurs only after sequential clinical and hemodynamic assessments have indicated maximum possible improvement in cardiac performance and its persistance after a period of trial with minimal assist. |
| Databáze: |
Supplemental Index |
| Externí odkaz: |
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