Sharps Cardiac Surgery Extubation Order Set Cardiac Surgery

Sharp’s Cardiac Surgery Extubation Order Set Cardiac Surgery Extubation Rapid Track Note: Pre-checked orders will be followed unless lined out. Patient Care Hemodynamic Parameter Instructions. Goals: Pa. CO 2=45 -55 torr; Immediate goal Et. CO 2 is ‘ 45; Sp. O 2>94%, begin wean from mechanical ventilation within 2 hours of admission to SICU CPAP Goal Patient care instructions. RCP and SICU nurse to collaborate in the adjustment of vent settings for change to CPAP, ABG and attainment of spontaneous respiratory mechanics, rapid shallow breathing index (RSBI), and extubation Spontaneous mechanics. During CPAP trial, acceptable parameters=VE 4 -10 L/min; VT 5 ml/kg or greater; RR=8 -24, RSBI less than 106 @ 1 min and 30 mins ABG-RCP. Arterial blood gases, 30 minutes after change to CPAP Medications q Propofol drip. 5 mcg/kg/min, IV, may increase by 5 mcg/kg/min every 5 min for agitation, max dose=80 mcg/kg/min Infuse propofol via central line with maintenance IV fluid whenever possible When ready to extubate, wean propofol by 10 mcg/kg/min every 5 minutes Notify provider. Notify anesthesiologist if dose of propofol greater than 50 mcg/kg/min Medication instructions. Adjust propofol infusion in accordance with extubation criteria and maintain patient in light sleep until just prior to extubation fenta. NYL. 25 mcg, amp, IV push, Q 5 MIN, PRN pain/discomfort, for 5 dose May give for Richmond sedation above -2 and RR>10 Prior to Extubation Patient Care Instructions. Progress toward CPAP based on Et. CO 2 and Sp. O 2 goals and hemodynamic stability per CVS parameters Extubation goal is <6 hours from admission to SICU Extubation. Ensure the patient is hemodynamically stable per surgeon’s parameters and extubate per rapid track pathway when Pt. awake & ABGs on Fi. O 2=<50% are met (p. H>7. 27, Pa. CO 2<55, Sa. O 2>94%, p. O 2/Fi. O 2>200) Ensure that Propofol has been d/c’d for at least 5 min, Pt can protect airway via cough & gag reflex, and raise head from bed for 5 seconds Communication Notify provider. Notify surgeon if unable to wean per rapid track pathway Notify provider. Notify surgeon for sedation orders if patient is not extubated within 6 hours and if mechanical ventilation may be required for >12 hours. Post-Extubation ABG-RCP. Arterial blood gases, PRN as determined by patient status Power. Plan End Time. D/C extubation rapid track postoperative order set with successful extubation Respiratory Rapid Track Mechanical Ventilation and Extubation Patient care instructions. Begin to wean from mechanical ventilation to CPAP per rapid track pathway Vent Settings. Upon arrival to SICU Peep 5 cm H 20 if SBP tolerates Fi. O 2 for Sp. O 2>94% For ASV mode: 100% min vol Ve target For SIMV/MMV/AC mode: Vt 6 -9 ml/kg; rate 10 -12/min; PS 10 cm H 2 O Oximetry daily continuous. Compare Sa. O 2 with Sp. O 2. Goal Sp. O 2>94%. Capnography/End Tidal Co 2. Compare Et. CO 2 with Pa. CO 2 Continuously titrate Ve or % Min Vol to maintain Pa. CO 2 to 45 -55 torr (or 35 -45 torr as estimated by Et. CO 2) ABG-RCP. Arterial blood gases, obtain ABGs 30 minutes after arrival to ICU Medications Nebulizer Treatment RCP Only. Nebulizer, Q 4 H, PRN Order, Wheezing Albuterol 0. 083% inh soln. 2. 5 mg, inh soln, NEB, Q 4 H, PRN wheezing Respiratory Oxygen Therapy. Post-extubation Sp. O 2 Goals >94% Incentive Spirometry. Q 1 HWA routine, 10 times every hour Hyperinflation protocol. As directed, PRN post-extubation Physician Signature: Date/Time: Patient Identification RN Signature: Date/Time: Source: Sharp Health. Care, San Diego, CA; Cardiovascular Roundtable interviews and analysis. VO/TO Readback: © 2015 The Advisory Board Company 1 advisory. com