ABSTRACT
These factors in the cardiac surgical patient are sepsis, over-feeding11 renal failure with fluid overload, marked neurologic dysfunction, and unstable hemodynamic status. Acute left ventricular dysfunction occurs in patients with COPD during the shift from mechanical to spontaneous ventilation12. Careful attention to fluid balance and aggressive diuresis or use of ultrafiltration13 ameliorates the abrupt rise in left ventricular filling pressure and allows
Neurologic Awake, following simple commands, able to protect airway
Neuromuscular blockade and opiates fully dissipated
Cardiac Stable; not on IABP, index >2.2 min –1 m-2
MAP >70; no serious arrhythmias
Respiratory Acceptable CXR, ABGs (pH =7.35) on minimal vent support
Secretions minimal; cough and gag reflexes present
Comfortable on CPAP or T -piece with spontaneous rate =24
and/or f/Vt ratio <100
Optional: MIP < –25; Vt >5 cm3 kg-1. Vc >10 cm3 kg –1
Renal Diuresing well; not markedly edematous
Urine output >0.5 cm 3 kg-1 min-1
Hematologic Chest tube drainage <50 cm3 h-1
Temperature Temperature >36.0°C
weaning from ventilation to proceed. It is not usual to find patients ‘unweanable’ until fluid removal reduces body weight to several kilograms below the preoperative value.
