Effects of volume controlled-equal ratio ventilation with recruitment maneuver and positive end-expiratory pressure in laparoscopic sleeve gastrectomy: a randomized controlled trial SUMMARY Background: The aim of this study was to investigate the effects of volume controlled-equal ratio ventilation (VC-ERV) on oxygenation, respiratory mechanics, and hemodynamic status during mechanical ventilation with recruitment maneuver (RM) and positive end-expiratory pressure (PEEP) in patients undergoing laparoscopic sleeve gastrectomy. Methods: Obese patients with scheduled for laparoscopic sleeve gastrectomy were randomized to receive inspiratory to expiratory ratio of 1:1 [Group VC-ERV (n: 56)] or 1:2 [Group VC-CRV (n: 55)] following tracheal intubation. …show more content…
All patients were continuously monitored for non-invasive blood pressure (NIBP), heart rate (HR), oxygen saturation (SpO2), end-tidal carbon dioxide (EtCO2), electrocardiogram (ECG) and, core body temperature. Preoxygenation was provided, at least 5 minutes, with supplemental oxygen (3 L/min) administered via a face mask during the monitoring procedure. A standardized anesthetic induction and maintenance was used and all drug dosages were calculated according to ideal body weight. General anesthesia was induced intravenously with propofol (1.5–2.5 mg/kg) and fentanyl (2 µg/kg), and tracheal intubation was facilitated with rocuronium (0.8 mg/kg) in the 30° reverse Trendelenburg position. A 20- gauge catheter was placed in the radial artery for arterial blood gas samples. Anesthesia was maintained with 2-3% sevoflurane in 50:50 oxygen and nitrous oxide and intravenous …show more content…
Respiratory rate (RR) was set to an EtCO2 between 30 and 40 mm Hg. Patients were then, randomly assigned to 1 of 2 ventilation protocols. Inspiratory-to-expiratory (I/E) time ratio was set as 1:1 and 1:2 in volume controlled-equal ratio ventilation (VC-ERV) and volume controlled-conventional ratio ventilation (VC-CRV) groups respectively. Randomization was provided using a computer-generated randomization list including 120 patients. The attending anesthesiologist was aware of the allocated group, but the data analyst, surgeon and the patients were blinded to group
While auscultating sounds of lung fields no wheezing was found, and VS were within normal range for patient as determined through comparison of chartings on 10/23/2015 thru the morning and lunch VS of 10/26/ 2015 before impaired gas exchange was detected. 10/26/2015 2. Administer O2 @ 2L N/C
When Sibert was not responding the anaesthetist then allowed a slow inhalation of Isoflurane to be delivered to patient through the face mask. When the patient was fully anaesthetised the author assisted the anaesthetist to secure the airway by passing size 4 Laryngoscope and size 8 endotracheal tube (ETT). The ETT was cuffed and tightly secured. Sibert was then transferred to the operating table and monitoring continued. Anaesthesia was maintained with O2, Isoflurane, and N2O on spontaneous ventilation with closed circuit.
Annette’s reason for admittance at the hospital is an overall weakness, flu-like symptoms, and difficulty with breathing (Prizio, n.d.). She is diagnosed with diabetic acidosis, left upper lobe pneumonia, and a bacterial infection (Prizio, n.d.). Unfortunately, her condition becomes worse. Annette’s right lung collapses, her heart rate is irregular, and she has an episode of unresponsiveness that leads to mechanical ventilation (Prizio, n.d.). Annette has challenges weaning off the mechanical ventilation, which resulted in the placement of a tracheostomy and percutaneous endoscopic gastrostomy tube (Prizio, n.d.).
Then the patient exhales passively. Increasingly, PSV is used in ICUs as the primary ventilation mode. PSV is thought to improve the endurance of respiratory muscles (Morton & Fontaine, 2013). This mode is not for patients who are sedated, or receiving neuromuscular blockade or having any pathological conditions that leads to unreliable breathing PSV is used as a weaning mode, or a recovery mode to boost the patients effort in maintaining a tidal volume. and tidal volume and RR should be monitored to detect any decreased compliance of the lungs.
Introduction Urologists are on the leading edge of laparoscopic surgery. It is now considered standard of care to perform in many operations. There are many benefits of laparoscopic surgery for a patient such as less blood loss, less pain, shorter time to oral intake and shorter hospitalization compared with open surgery.1 However laparoscopic surgery is a kind of vigilant work. There is more stressful than open surgery.
This procedure was repeated again. After the second time performing the FVC and FEV1 standing, the procedure was then repeated from step 1-3 lying supine. Second part of the lab was to measure Maximal Voluntary Ventilation (MVV12). The individual took a clean nose clip and tube.
Sedation and analgesia can be administered by an anesthesiologist or non-anesthesiologist as intermittent boluses or continuous infusion throughout the procedure. Moreover, patient controlled sedation and target controlled infusion are alternative modes of drug delivery. Anesthesiologist versus non-anesthesiologist debate Debate exists on whether the staff administering sedation should be an anesthesiologist, a gastroenterologist or a non-anesthesiologist (70, lit). Although, reports suggesting the safety of sedation administered by non-anesthesiologists exist in the literature, incidence of adverse hemodynamic and airway events were reported as 1.44% and 0.74% respectively (36-41). The reasons behind nurse rather than physician organizations
The study measured the number of patients who could not reach a therapeutic respiratory goal from the ventilatory support they were placed on and was then switched over to the other form of ventilation. They concluded that those patients who required to switch over to
In order to assess the efficacy of patients respiratory effort RSBI is calculated from the ratio of tidal volume to the respiratory rate. If the respiratory rate is 12 and the tidal volume is 400 RSBI=12/0.4=30. An RSBI less than 80-100 is considered ready for liberation. However, this index should not be the only
Sedation Management Over-sedation in mechanically ventilated patients is common issues in a critical care setting. According to findings by Wøien, Vaerøy, Aamodt, and Bjørk (2012), as much as "30-60% of intensive care patients receive periods of prolonged sedation" (p. 1552). Also, deep sedation was associated with an "increase in mortality, prolonged mechanical ventilation, and increased intensive care unit length of stay" (DAS-Taskforce, 2015). Current literature generates a level of personal interest and clinical significance to nursing practice.
While these types of drugs are known to depress respiratory effort, situations like this unfortunately occur with great rate, especially in critical care units where opiate narcotics and benzodiazepine sedatives are daily drugs in clinical practice. These types of drugs require special diligence and awareness by the nurse to guarantee safe
Later, ventilation–perfusion mismatching was found to be the major factor (38) and that a diffusion barrier to oxygen was only important during exercise(39). These physiologic measurements aid not only in diagnosis, and to assess disease severity, but also to evaluate the response to therapy, and to follow the course of the
This proposal will address the reasons for the clinical neglect of respiratory rate assessment in acute setting despite of its importance such as detecting early deterioration in patients. Reasons include, inadequate knowledge and skills, patient acuity and lack of time. Does it reflect the dimensions of quality (Week 4 Lecture) is it safe, effective, person-centred, timely efficient and
POST BIOPSY OBSERVATION No specific monitoring is required following an uncomplicated biopsy procedure. Most complications are known to occur within one hour of the procedure, therefore patient was kept in the hospital for at least one hour or longer if pneumothorax occurred. Chest radiographs are reviewed by radiologist.
Assessment is a fundamental component of any nurse’s role. However, from what I observed today it seems particularly vital to the PACU nurse. While they do provide interventions, the majority of PACU nurses’ time is spent assessing their patients and documenting their findings. Patients in the PACU have undergone the significant stressor of surgery under general anesthesia and they have the potential for very serious complications. It is up to the PACU nurse to observe if the patient is declining and act quickly and appropriately.