1 / 16

The role of the perfusionist Conny Rundby

The role of the perfusionist Conny Rundby. Dep. of Cardiothoracic Surgery & Anesthesiology Karolinska University Hospital Stockholm. Introduction. Protocol for weaning - criteria and procedure The implementation - gathering and evaluation

rufin
Télécharger la présentation

The role of the perfusionist Conny Rundby

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. The role of the perfusionistConny Rundby Dep. of Cardiothoracic Surgery & Anesthesiology Karolinska University Hospital Stockholm

  2. Introduction Protocolfor weaning- criteria and procedure The implementation- gathering and evaluation All that “other stuff”- incidents, troubles and state of mind

  3. The criteria HARPS -The Harefield Recovery Protocol Study- On minimal LVAD flow: LVEDD < 6 cm Left Ventricular End Diastolic Diameter LVESD < 5 cm Left ventricular end-systolic diameter LVEF > 45% Left ventricle ejection fraction PCWP < 12 mmHg Pulmonary capillary wedge pressure Cardiac Index > 2.8 L/min/m2 Peak VO2 > 16 ml/kg/min VE/VCO2 < 34 (VE) The ratio between total ventilation and production of CO2. The VE/VO2 is an index of ventilatory efficiency

  4. The criteria

  5. The protocol

  6. The protocol

  7. The protocol Before procedure: 2 PVK administration / blood-samples Blood-samples: electrolytes, krea, Hct, platelets CRP, INR, APTT INR>2 At all attempts: Time, rpm, flow, power, PI Symptoms, Doppler BP, HR, 02-sat EF, LVEDD

  8. The protocol Flow dec. 400 rpm every fifth minute to 8000 rpm From 8000 rpm: Full heparinisation ACT >400 Flow dec. 400 rpm every third min to 6000 rpm At every rpm level registration of parameters and symptoms Rigorous echo exam. flow-direction, septum, RV, LV, EF, LVEDD, Ml, Aortic valve

  9. The protocol At 6000 rpm: Parameter check every second minute. After 10 minutes: Rigorous echo exam Exercise test bicycle / treadmill Echo exam Inc. 400 rpm every other minute to 9000 rpm Normalisation of ACT (<200)

  10. The protocol - evaluation

  11. The protocol - evaluation

  12. The protocol - evaluation

  13. Important points • EF 65-80% • LVEDD 37-40 • Slightly reduced global RV function • Lower peak SBP at 6000 than at 9000 rpm • De-conditioned. Improvement due to training • Peak V02 improving • A low V02 can be derived from de-conditioning and high VE/VC02 from anxiety

  14. Troubles & Incidents Bleeding, haematoma and vagal reaction Infection Difficulty to participate / low acceptance for the diagnostic equipment Protaminisation regime – pros and cons What do the values and results really stand for?

  15. Troubles & Incidents Exposure & state of mind

  16. Thank you for your attention

More Related