Comparison of mechanical and manual ventilation during transport of patients to the intensive care unit after cardiac surgery

Abstract

Objectives: We compared effects of mechanical and manual ventilation during transport to the intensive care unit(ICU) in cardiac surgeries. Materials and methods: After ethical approval, 66 patients (ASAgrade II and III, 20-80years) were assigned randomly. Ventilation during transport to ICU was performed manual (Group EV; n=36) or mechanical ventilation (Group MV; n=30). Measurements were recorded: operation room (A), during transport (T) and in ICU (YB). Systolic, diastolic pressures (SAP, DAP), pulmonary arterial pressure (PAP), pulmonary capillary wedge pressure (PCWP), central venous pressure (CVP), heart rate (HR), cardiac output (CO), blood gases (pH, PCO2, PO2, BE) and peripheral oxygen saturation (SpO2) were recorded. Stroke volume index (SVI), systemic and pulmonary vascular resistance indices (SVRI, PVRI) and mean arterial pressures(MAP) were calculated. Results: Patients were similar. Duration of transport was shorter in Group MV (p< 0.01). The alterations in HR, MAP, DAP, CVP, PAP, PCWP, PVRI, SVRI, SVI, CO, SpO2 were similar, the increase in SAP during T period was higher in Group MV (p

Keywords

• Cardiac surgery, patient transport, mechanical ventilator, manual ventilator, hemodynamia

Kardiyak cerrahi ameliyatlarından sonra hastaların yoğun bakıma transportları sırasında mekanik ventilasyon ile elle ventilasyonun karşılaştırılması

Abstract

Amaç: Kardiyak ameliyatlar sonrası, yoğun bakıma transportta mekanik ve el ventilatörünün etkilerini karşılaştırdık. Gereç ve yöntem: Elektif kardiyak cerrahi uygulanan 66 hasta (ASA II- III, 20-80yaş) rastgele iki gruba ayrıldı. Hastaların yoğun bakıma transportlarında el ventilatörü (Grup EV; n=36) veya mekanik ventilatör (Grup MV; n=30) kullanıldı. Ölçümler, ameliyathane masasında (A), transport esnasında (T) ve yoğun bakımda (YB) kaydedildi. A ve YB\'da sistolik arter basıncı (SAB), diyastolik arter basıncı (DAB), kalp atım hızı (KAH), santral venöz basınç (SVB), ortalama pulmoner arter basıncı (PAB) ve pulmoner arter kapiller oklüzyon basıncı (PAOB), kalp debisi (KD), kan gazları ve periferik oksijen saturasyonu (SpO2) değerleri, T\'ta SAB, DAB, KAH, SpO2 ve transport süresi (TS) kaydedildi. Atım hacmi indeksi (Stroke volume index;SVI), sistemik vaskuler rezistans indeksi (SVRI), pulmoner vasküler rezistans indeksi (PVRI), ve ortalama arteriyel basınç (OAB) hesaplandı. Bulgular: Hasta özellikleri benzerdi. Transport süresi MV Grubunda daha kısaydı (p< 0.01). Gruplarda KAH, OAB, DAB, CVP, PAP, PCWP, PVRI, SVRI, SVI, CO, SpO2\'deki değişiklikler farksızken, T döneminde SAB\'da Grup MV\'deki artış belirgindi (p

Keywords

• Kardiyak cerrahi, hasta transportu, mekanik ventilatör, el ventilatörü, hemodinami

References

1. Martins BS, Shojania KG. Safety During Transport Of Critically Ill Patients. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/ ptsafety
2. Joint Faculty of Intensive Care Medicine Australian and New Zealand College of Anaesthetists Review IC-10 2003. http://www.jficm.anzca.edu.au/publications/pol- icy/ic10_2003.htm
3. Warren J, Robert E, Richard A, Leo C. Rotello, H. Mathilda Horst. Guidelines for the inter- and intrahos- pital transport of critically ill patients. Crit Care Med 2004;32(1):256-62.
4. Shekhar T. Intrahospital transport of critically ill children-Should we pay attention? Crit Care Med 1999;27(4):694-5.
5. Daniel MT, Hillel Z, Schwartz AJ. Care of cardiac surgi- cal patients, In: Textbook of cardiothorasic Anesthesi- ology 2003;33(7):846-7.
6. Insel J, Weissman C, Kemper M, Askanazi J, Hy- man AI. Cardiovascular changes during transport of critically ill and postoperative patients. Crit Care Med 1986;14 (6):539-42.
7. Waddell G. Movement of criticall ill patients within hos- pital. Br Med J 1975;2(5968):417-9.
8. Hurst JM, Davis K Jr, Branson RD, Johannigman JA. Comparison of blood gases during transport us- ing two methods of ventilatory support. J Trauma 1989;29(12):1637-40.

9. Taylor JO, Chulay, Landers CF, Hood W Jr, Abelman WH. Monitoring high-risk cardiac patients during trans- portation in hospital. Lancet 1970 12;2(7685):1205-8.
10. Evans A, Winslow EH. Oxygen saturation and hemo- dynamic response in critically ill, mechanically venti- lated adults during intrahospital transport. Am J Crit Care 1995;4(2):106-11.
11. Schirmer U, Heinrich H, Siebeneich H, Vander- meersch E. Safe intra-clinic transport of intensive- care patients. A concept that avoids monitoring and treatment gaps. Anasthesiol Intensivmed Notfallmed Schmerzther 1991;26(2):112-5.
12. Nagappan R. Transit care medicine--a critical link. Crit Care Med. 2004;32(1):305-6.
13. Braman SS, Dunn SM, Amico CA. Complications of intrahospital transport in critically ill patients. Ann In- tern Med 1987;107(4):469-73.
14. Dockery WK, Futterman C, Keller SR, Sheridan MJ, Akl BF. A comparison of manual and mechanical ventilation during pediatric transport. Crit Care Med 1999;27(4):802-6.
15. Waydhas C. Intrahospital transport of critically ill pa- tients. Crit Care 1999;3(5): R83-9.
16. Nakamura T, Fujino Y, Uchiyama A, Mashimo T, Nishimura M. Intrahospital transport of critically ill pa- tients using ventilator with patient-triggering function. Chest 2003;123(1):159-64.
17. Miyoshi E, Fujino Y, Mashimo T, Nishimura M. Perfor- mance of Transport Ventilator With Patient-Triggered Ventilation. Chest 2000;118(4):1109-15.
18. Amato MB, Barbas CS, Medeiros DM, et al. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med. 1998;338(6):347-54.
19. Hensley FA, Martin DE. Anesthetic management for cardiac surgery. In: A practical approach to cardiac an- esthesia. Second edition. Little, Brown and Company; 1995;9:251-2.
20. Hensley FA, Martin DE, Gravlee GP. Anesthetic management for cardiac surgery. In: A practical ap- proach to cardiac anesthesia. Third edition. Lippincott Williams&Wilkins; 2003;10;254-5.
21. Weg JG, Haas CF. Safe intrahospital transport of critically ill ventilator-dependent patients. Chest 1989;96(3):631-5.
22. Gervais HW, Eberle B, Konietzke D, Hennes HJ, Dick W. Comparison of blood gases of ventilated patients during transport. Crit Care Med 1987;15(8):761-3.
23. Lovell MA, Mudaliar MY, Klineberg PL. Intrahospital transport of critically ill patients: complications and dif- ficulties . Anaesth Intensive Care 2001;29(4):400-5.
24. Stearley HE. Patients’ outcomes: intrahospital trans- portation and monitoring of critically ill patients by a specially trained ICU nursing staff. Am J Crit Care 1998;7(4):282-7.
25. Wallen E, Venkataraman ST, Grosso MJ, Kiene K, Orr RA. Intrahospital transport of critically ill pediatric pa- tients. Crit Care Med 1995;23(9):1588-95
26. Smith I, Fleming S, Cernaianu A. Mishaps during transport from the intensive care unit. Crit Care Med 1990;18(3):278-81.
27. Szem JW, Hydo LJ, Fischer E, Kapur S, Klemperer J, Barie PS. High-risk intrahospital transport of critically ill patients: safety and outcome of the necessary “road trip”. Crit Care Med 1995;23(10):1660-6.
28. Swoboda S, Castro JA, Earsing A K and Lipsett AP. Road trips and resources: there is a better way. Criti- cal Care 1997;1(3):105-10.