Cardiac Anesthesia Case Study

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Chapter One 1.1: Introduction Cardiac surgical intervention has become a common method of treating coronary artery diseases and valvular dysfunction; weaning from mechanical ventilation and endotracheal extubation usually proceeds straightforwardly. Failure of the patients to tolerate extubation may reflect premature extubation or may be a marker of sicker patients. Premature extubation may lead to hypercarbia, hypoxia, pulmonary hypertension, right heart failure, and myocardial ischemia (Sabzi and Teimouri 2007). Cardiac surgery carries a relatively high morbidity and mortality compared with most other surgical procedures. This is not only due to the nature of the surgery itself, but also to the presence of cardio-respiratory…show more content…
The efforts of physicians to ensure early extu¬bation of patients are supporting this policy in most ICUs, and a vast majority of patients are successfully extubated within 6 to 8 hours after their surgery. However, in spite of this, a large number of patients requiring mechanical ven¬tilation still remain in the ICU for > 24 or 48 h. The appropriate identification of these patients could be of interest for planning ICU resources when the patient enters the unit (Amirghofran…show more content…
Prolonged mechanical ventilation was calculated to cost $55,460 per life-year gained and $82,411 per quality-adjusted life-year gained compared with withdrawal of ventilation. Advancing age was a major variable affecting this economic cost analysis (Cox 2007) The number of patients who receive mechanical ventilation as life support is rapidly increasing due to improvements in life saving medical therapy in critically ill patients, an aging population and the expanded use of aggressive surgical procedures. The historic annualized increase in prolonged mechanical ventilation use in the U.S. is approximately 5.5% compared with a 1% per annum increase in U.S. hospital admissions. It is estimated that the population of patients who receive prolonged mechanical ventilation in the U.S. will more than double by the year 2020 and reach approximately 605,898 cases (Zilberberg
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