Hepatic Ischema Case Study

CLINICAL FINDINGS/TREATMENT My patient underwent surgery for repair of the COA by using a combination of end to end repair with use of an anterior patch technique. He came out of surgery on ventilator support and remained on the ventilator until he was cleared by the physician and he could maintain his own respiratory efforts and was clear of all other post-operative complications.

We used a ServoI with the settings as follows:

Vt 45ml, Ti .65, Peep 5cmH2O, RR 30, FiO2 40%

ABG results: pH 7.41, PaCO2 30mmHg, PaO2 172mmHg, SaO2 99%, HCO3 21, BE 5.3

After ABG results the rate was decreased to 25/min and FiO2 was decreased to 30%.

Cross clamping was required on three occasions. Cross clamping during this procedure is extremely important to note and time due to the complications. Complications that can occur are renal failure, hepatic ischemia and coagulopathy, bowel infarction, and paraplegia. In this patient case, due to the number of cross clamping and duration of each one paraplegia was a concern. He did however regain all sensation and movement within 24 hours of surgery. My

The nursing staff could wean the patients’ nitroglycerin drip as well as morphine and versed (drugs used for pain management and a sedative), overnight. After his initial morning assessment by respiratory, nursing, and his physician, respiratory was given the order to assess weaning parameters and perform a spontaneous breathing trial for possible extubation. The patient was breathing over the rate with adequate volumes, with a RSBI of 52. At this time, we placed the patient on pressure support with minimal settings to see what he could do on his own, Pressure Support settings of 10/5, 21% FiO2. This patient well exceeded normal limits and the physician placed the order for extubation. Extubation was successful with no complications, and the patients parents were ecstatic to finally hold their little baby