Effect of Mode of Transport Ventilation on Respiratory Parameters After Cardiac Surgery
| Status: | Recruiting |
|---|---|
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 4/21/2016 |
| Start Date: | August 2015 |
| Contact: | Edward O'Brien, MD |
| Email: | e1obrien@ucsd.edu |
| Phone: | 619-543-6240 |
After cardiac surgery patients are transported from the operating room (OR) to the intensive
care unit (ICU) while intubated. Two principal methods of oxygenation and ventilation are
used: (1) a transport ventilator or (2) a Mapleson Bag-Mask hand ventilating circuit. The
choice of method is largely determined by the preference of the the anesthesiologist who is
transporting the patient. The investigators postulate that the choice of either method might
alter respiratory and hemodynamic parameters felt to be important for the immediate
management of post-cardiac surgery patients. The investigators will prospectively record
end-tidal carbon dioxide (ETCO2) (primary end-point) and change in minute volume, heart rate
(HR), Blood pressure (BP), pulmonary artery (PA) pressures and cardiac output during
transportation and upon arrival in the ICU. All of these variables are measured routinely
but are not recorded. The investigators will compare patients transported with a ventilator
to patients transported with a Mapleson circuit.
care unit (ICU) while intubated. Two principal methods of oxygenation and ventilation are
used: (1) a transport ventilator or (2) a Mapleson Bag-Mask hand ventilating circuit. The
choice of method is largely determined by the preference of the the anesthesiologist who is
transporting the patient. The investigators postulate that the choice of either method might
alter respiratory and hemodynamic parameters felt to be important for the immediate
management of post-cardiac surgery patients. The investigators will prospectively record
end-tidal carbon dioxide (ETCO2) (primary end-point) and change in minute volume, heart rate
(HR), Blood pressure (BP), pulmonary artery (PA) pressures and cardiac output during
transportation and upon arrival in the ICU. All of these variables are measured routinely
but are not recorded. The investigators will compare patients transported with a ventilator
to patients transported with a Mapleson circuit.
After cardiac surgery, patients can have poor respiratory function and hemodynamics. The
exact cause and contributing factors of this deterioration are not usually known and, often
these patients demonstrate normal parameters at the end of surgery, but are significantly
altered upon arrival in the ICU. Transportation of patients from the OR to the ICU is a
period of significantly less intense monitoring and less well-controlled interventions (for
example tidal volume (Vt) is largely arbitrary). Recent evidence suggests that the risk of
intra-hospital transportation is significantly higher for ventilated patients than for all
other patients. Some of this risk might be mitigated by the mode of ventilation because
pulmonary and hemodynamic parameters are rarely measured during transportation. If the
method used for ventilation and oxygenation during transport is important in maintaining
stability upon presentation to the ICU, clinicians might choose one method over another.
This would change clinical practice.
This is a prospective observational study assessing the effect of different modes of
transport ventilation on respiratory and hemodynamic parameters on post cardiothoracic (CT)
surgery patients admitted to the ICU. It is standard of care to measure peripheral blood CO2
(either end-tidal or arterial), minute volume, heart rate, blood pressure, cardiac output
and pulmonary artery pressure for all patients admitted to the ICU after cardiac surgery.
The investigators will simply record these values during transport and immediately on
arrival in the ICU. At a 2 sided significance level of 0.05, the investigators will enroll
32 patients to detect a minimal difference from baseline ETCO2 of 15% at a power of 0.8.
The investigators will review each subjects medical record to obtain vital sign information
and ventilatory parameters. The investigators will obtain individual HIPAA authorization
from each subject.
All subjects will have just undergone cardiac surgery are intubated and are being
transported to the ICU with either method of ventilation. The patients will be adult (age 18
and over who are competent to give their own consent). They will be recruited prior to
surgery according to the inclusion and exclusion criteria listed below. No consideration
will be made to gender, race, sexual orientation or national origin.
exact cause and contributing factors of this deterioration are not usually known and, often
these patients demonstrate normal parameters at the end of surgery, but are significantly
altered upon arrival in the ICU. Transportation of patients from the OR to the ICU is a
period of significantly less intense monitoring and less well-controlled interventions (for
example tidal volume (Vt) is largely arbitrary). Recent evidence suggests that the risk of
intra-hospital transportation is significantly higher for ventilated patients than for all
other patients. Some of this risk might be mitigated by the mode of ventilation because
pulmonary and hemodynamic parameters are rarely measured during transportation. If the
method used for ventilation and oxygenation during transport is important in maintaining
stability upon presentation to the ICU, clinicians might choose one method over another.
This would change clinical practice.
This is a prospective observational study assessing the effect of different modes of
transport ventilation on respiratory and hemodynamic parameters on post cardiothoracic (CT)
surgery patients admitted to the ICU. It is standard of care to measure peripheral blood CO2
(either end-tidal or arterial), minute volume, heart rate, blood pressure, cardiac output
and pulmonary artery pressure for all patients admitted to the ICU after cardiac surgery.
The investigators will simply record these values during transport and immediately on
arrival in the ICU. At a 2 sided significance level of 0.05, the investigators will enroll
32 patients to detect a minimal difference from baseline ETCO2 of 15% at a power of 0.8.
The investigators will review each subjects medical record to obtain vital sign information
and ventilatory parameters. The investigators will obtain individual HIPAA authorization
from each subject.
All subjects will have just undergone cardiac surgery are intubated and are being
transported to the ICU with either method of ventilation. The patients will be adult (age 18
and over who are competent to give their own consent). They will be recruited prior to
surgery according to the inclusion and exclusion criteria listed below. No consideration
will be made to gender, race, sexual orientation or national origin.
Inclusion Criteria:
- Adults scheduled for elective cardiac surgery.
- No known pulmonary disease prior to surgery.
Exclusion Criteria:
- Patients who refuse to participate, patients under the age of 18, groups with known
cognitive impairment, patients who are unable to consent or institutionalized
individuals.
- Patients who are not expected to remain intubated after cardiac surgery.
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