Open-Heart Surgery
Open-heart surgery is the broad term to define the need to make an incision in the chest to correct and fix abnormalities affecting heart production. The most common type of heart surgery: Coronary artery bypass grafting which improves the blood flow to the heart (Types of Heart Surgery NHLBI, 2013). The procedure involves using a healthy artery or vein from the body and connecting/grafting, to the blocked coronary artery. The grafted artery or vein bypasses the blocked portion, creating a new path for oxygen-rich blood to flow to the heart muscles (Types of Heart Surgery NHLBI, 2013). Postoperatively atelectasis and reduced lung volumes are common and should be treated quickly. The effects of the median sternotomy, hypothermia for myocardial
protection dissection of the internal mammary artery, and the use of cardiopulmonary bypass negatively influence lung function (Urell et. al, 2012). The reduction in lung function could lead to acute respiratory failure and is associated with an increased morbidity and mortality. With the, “normal” open-heart patient following surgery the patient will be on mechanical ventilation. Typically following open heart surgery the goal is to extubate the patient within twelve hours following surgery. Early weaning of patients from mechanical ventilation after surgery enhances the cardiopulmonary function and early ambulation, reduces length of ICU/hospital stay, and improvement in the intrapulmonary shunt fraction after extubation (Totonchi, Baazm, Chitsazan, Seifi, & M Chitsazan, 2014). Once the patient is extubated the initial practice is to place the patient on low-flow oxygen therapy. If the low-flow oxygen is insufficient at correcting hypoxemia the next option historically has been NIV (BiPAP) to prevent respiratory failure. Today, there are several different approaches to treating acute respiratory failure following open-heart surgery, including NIV, Continuous positive airway pressure (CPAP), BiPAP, High flow nasal oxygen, and Optiflow. CPAP is often used to wean
protection dissection of the internal mammary artery, and the use of cardiopulmonary bypass negatively influence lung function (Urell et. al, 2012). The reduction in lung function could lead to acute respiratory failure and is associated with an increased morbidity and mortality. With the, “normal” open-heart patient following surgery the patient will be on mechanical ventilation. Typically following open heart surgery the goal is to extubate the patient within twelve hours following surgery. Early weaning of patients from mechanical ventilation after surgery enhances the cardiopulmonary function and early ambulation, reduces length of ICU/hospital stay, and improvement in the intrapulmonary shunt fraction after extubation (Totonchi, Baazm, Chitsazan, Seifi, & M Chitsazan, 2014). Once the patient is extubated the initial practice is to place the patient on low-flow oxygen therapy. If the low-flow oxygen is insufficient at correcting hypoxemia the next option historically has been NIV (BiPAP) to prevent respiratory failure. Today, there are several different approaches to treating acute respiratory failure following open-heart surgery, including NIV, Continuous positive airway pressure (CPAP), BiPAP, High flow nasal oxygen, and Optiflow. CPAP is often used to wean