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- Dec 3, 2003
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Yesterday's case was very interesting. 34 y/o w history of OLT @10 years of age, now with ESRD on CRRT, end stage liver disease, profoundly anemic Hgb 6.7/ 20 mental status altered sedated intubated now with posterior fossa possible cerebellum bleed, also profoundly coagulapathic Factor 7 given at the bedside which in addition to 8 units of FFP corrected the coagulopathy. Started the case with the belmont hooked into the subclavian quinton catheter infusions through IJ double lumen. Started the case on Norepinephrine pt was in florid urosepsis VRE in urine as soon as the agent was turned on bp tanked added some epinephrine(thought process was that she was on heavy dose of NE 10mcg/min must be a contractility issue) Could not transfuse the CVP as we had too many infusions hooked in. Bleeding was profuse throughout the case lost about 3.0L of blood. Transfused roughly 6 units prbc and 6 units of ftp 2 five packs of platelets also gave Novaseven during the case(not very good evidence to use Nova7 inter operatively) . Another good clinical pearl pt was in presumed DIC you give 1U of FFP for every unit of PRBC given. At the end of the case we kept the patient intubated. Vent settings were quite high PEEP of 8, peak pressures with adequate TV 6ml/kg in the 40's likely this was early ARDS. Called for an ICU ventilator because of the high vent settings high peep and Pinsp. It could be presumed that her respiratory failure was secondary to decrease compliance, my staff advocated for shorter inspiratory times( I thought this was wrong in that her Peak pressures were equal to her plateau pressures IE her problem was a compliance issue. Using this equation Ppk=VT/C + Flow rate x resistance. Her issues were all compliance related so any increase in Peak pressure would be transmitted to the alveolus resulting in barotrauma, atelectrauma, and worsening our situation.
To the old school guys what are the advantages of an ICU ventilator over a anesthesia machine ventilator? We all understand better PEEP settings, and more efficient volumes.
To the old school guys what are the advantages of an ICU ventilator over a anesthesia machine ventilator? We all understand better PEEP settings, and more efficient volumes.