Case scenario as follows: 70 yo M with hx of DM and HTN who has a left hip replacement at an outside hospital three weeks prior presents with neck pain, inability to ambulate, fever and lethargy. Work up shows a large cervical epidural abscess, new hip is aspirated and shows pus and he reports several joints that are tender. The neurosurgeon books a multilevel posterior decompression, washout and fusion to start at 11pm. The patient arrives in the PACU AOx1, somnolent and febrile. You start the case and it goes fairly smoothly, guy requires a neo infusion throughout the case and into the PACU and ABGs drawn off the blood gas show metabolic acidosis. At the end of the case the surgeon is really pushing to extubate because “he doesn’t need to be kept intubated for no reason.” I fought him saying he has a fresh cervical fusion, poor mental status, multiple sites of infection and has the potential to become floridly septic. I get “sepsis isn’t a reason to keep someone intubated” from the surgeon. WTF
Am I being unreasonable and is there some new approach here? I have been out of training for a bit but I was always taught to keep certain patients intubated post op; sepsis, poor mental status, large volume resuscitation, and those requiring large amounts of hemodynamic support keep the tube until proving they no longer need it.
Am I being unreasonable and is there some new approach here? I have been out of training for a bit but I was always taught to keep certain patients intubated post op; sepsis, poor mental status, large volume resuscitation, and those requiring large amounts of hemodynamic support keep the tube until proving they no longer need it.