[HSF] Ain't that big !!

[Nasser F. Abou'Seada]

was the patient in documented AF ????? "...of Course ..!!" ...
what was the rhythm on weaning from CPB ???? ... before skin closure ?? ..
in CSICU ?? ... 
incidentally ... why ventilating @ TV 7mls/kg BW ? 
and ... what do you mean by open lung ventilation ? ... apparently your pt
is on IMV/Assist mode ..?
Do You keep the PEEP at 20 mmHg for 60 sec continuously ??? ... 

NFA

> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-
> bounces at lists.hsforum.com] On Behalf Of prasannasimha
> Sent: Monday, November 20, 2006 1:12 PM
> To: OpenHeart-L at lists.hsforum.com; ccm
> Subject: [HSF] Ain't that big !!
> 
> Patient with 97 % CTR, Giant LA , Mitral stenosis (MVOA 0.8) with MR
> Grade II with LA body clot.
> Underwent today MV repair + LA thrombectomy + eMAZE  +Kawazoe type of
> plication to decompress the compression on the right lung.. Second X Ray
> in the Panel is the immediate post op X Ray showing the "atelectatic"
> lung opening up slowly.
> At present the patient is being given "open lung ventilation"  with
> ventilation  @ 7ml/Kg tidal volume with PEEP of 14 mm Hg with hourly
> increase of PEEP @ 20mm Hg  for 45 - 60 seconds hourly to expand the
> chronically compressed lung and will probably be extubated in a few hours.
> Papery thin LA in certain areas !!
> I am getting a spate of giant LA's - todays other case also required an
> atrioplasty + MV repair (though that giant LA has a CTR of 80 % - less
> dramatic than the 97 % !!)!! When it rains it pours !!
> Prasanna