How Long Does A Critically Ill Patient Stay On A Ventilator After Open Heart Surgery
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This is another episode of YOUR QUESTIONS ANSWERED and in last weeks episode I answered another question from one of our readers and the question last week was
You can check out the answer to last weeks question by clicking on the link here.
In this weeks episode of YOUR QUESTIONS ANSWERED, I want to answer another frequently asked question from our readers and the question this week is
How long does a critically ill Patient stay on a ventilator after open heart surgery?
Many Patients are admitted to Intensive Care because they need open heart surgery . Open heart surgery is always followed by a stay in Intensive Care or Critical Care!
Open-heart surgery is any type of surgery where the chest is cut open and surgery is performed on the muscles, valves, or arteries of the heart.
Most Intensive Care Units, most cardiac surgeons and most hospitals follow pathways after open heart surgery/cardiac surgery.
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Criteria For Extubation And Definition Of Postoperative Ventilator Dependency
Criteria for extubation included an alert and hemodynamically stable patient with no excessive bleeding, ability of the patient to breathe through a T tube for at least 30 minutes with a fraction of inspired oxygen of less than 0.40 and a respiratory rate less than 25 breaths/min, an arterial blood PO2 greater than 70mmHg, a PCO2 less than 40mmHg and a pH greater than 7.35, with no metabolic acidosis. Other criteria included a tidal volume of 6ml/kg, a peak negative inspiratory pressure of less than -20cmH2O and a mandatory chest radiograph before extubation to rule out pneumothorax, pleural effusion and atelectasis.
With reference to previous reports where 48 hours was taken as a cut off point to discriminate whether PVD or not , we used the same criterion in this study to describe PVD, that is elapsed time between CABG and extubation of more than 48 hours was defined as ventilator dependency following CABG.
Remember To Move Carefully
- Rapid change of position may be accompanied by dizziness if done to quickly.
- Rest whenever you get tired.
- Rest between activities. If you need to rest for more than one hour after an activity, you may be pushing yourself too hard. Do a little less the next day.
- Avoid placing undue strain on your chest region by sitting in one position for long periods of time.
- When sitting or standing, use your leg musclesdo not use your arms to lower or raise yourself from your chair.
- Do not cross your legsit interferes with blood flow.
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How Long After Surgery Does It Take To Wake Up
Following Surgery If you were sedated or under general anesthesia, don’t expect to be completely awake immediately away it may take some time, and you may nod off for a while. It normally takes 45 minutes to an hour to fully recover from general anesthesia. You should be given medication to help you sleep if needed after your surgery.
How Long After Open Heart Surgery Do You Wake Up
You may not be able to wake up for two to four hours after being sedated. During this period, you will continue to breathe through the breathing tube with the assistance of a ventilator, which is a machine that moves air into and out of your lungs, basically “breathing” for you. After about four hours, most patients can be woken up.
Most patients are able to walk around within an hour of waking up and return to normal activities within days. However, more vigorous activity should be avoided for several weeks following open-heart surgery because of the risk of further clogging arteries due to the extra blood flow to major organs such as the brain and kidneys that occurs during exercise.
It is important to remember that you were given a number of medications after open heart surgery, including:
Antibiotics – These prevent infections from developing after open heart surgery. Most often, antibiotics are prescribed following open heart surgery indefinitely until postoperative tests show there no longer is a threat of infection.
Anti-arrhythmics – These help control abnormal heart rhythms that can occur after open heart surgery. Anti-arrhythmic drugs can be used both before and after open heart surgery.
Beta blockers – These reduce the workload of the heart by slowing down its response to stress.
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Living A Full Life Again
During the months of illness before heart transplant surgery, you and your family made many adjustments. The purpose of having heart transplant surgery was to make you feel better and to live a full life again. Let’s review some areas of life often affected by your transplant.
Daily Activity and Exercise Guidelines
Caring for your personal hygiene
It takes about six weeks for your sternum to heal after heart transplantation. During this time, you may do light household chores such as laundry, shopping, cooking, and washing dishes. But, do not lift objects that weigh more than 10 pounds. These include suitcases, grocery bags, full laundry baskets, pets or children.
Also avoid activities that require pushing or pulling heavy objects, such as shoveling snow or mowing the lawn. Your doctor will tell you when you can resume these activities during your heart transplantation follow-ups.
Driving after your heart transplantation
You may not drive for at least six weeks. However, you may be a passenger as often as you like. For the first two weeks after your heart transplantation, you may want to stick close to home to avoid infections or becoming overtired. Over time, increase your outings and begin to get back to activities you enjoy after your heart transplantation. Your doctor will tell you when you can begin driving a car.
Get a good night’s sleep
Begin a Lifelong Exercise Program After Your Heart Transplantation
Exercise will help you:
What Are The Risks Of Off
Off-pump CABG may provide a slightly lower risk of complications than CABG performed with a heart-lung machine. Your particular risks will vary according to your particular medical conditions, your age, and other factors. In the off-pump technique, there may be a higher risk of needing another procedure to improve the hearts blood supply in the future. Be sure to talk with your healthcare provider about any concerns that you have.
Most people who have off-pump CABG will have a successful outcome. However, there are some possible risks. These include:
Certain factors increase the risk of complications. These include increased age and other medical conditions.
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How Do Anesthesiologists Wake You Up
If general anesthesia is utilized, the anesthesiologist will begin the process of converting you from a normal waking state to a drowsy condition of anesthesia. This is known as induction, and it is often accomplished by either injecting drugs through an IV or breathing gases through a mask. The anesthesiologist may also be able to achieve this same result with only local anesthesia if necessary.
Once you are under the influence of anesthesia, doctors will use various methods to try and wake you up without causing further damage to your brain. These methods include oxygenation via mask or cannula, coughing, mechanical stimulation , and finally injection of a drug called atropine. Atropine is used because it works on all types of anesthesia, it does not cause other problems when administered during surgery, and it can always be reversed if needed.
Anesthesiologists generally attempt to keep you asleep during surgery so that you do not feel anything important is happening. They may also want to avoid having you wake up too soon after they stop administering drugs, since this might cause you to lose muscle tone and possibly fall out of bed unassisted.
After surgery is complete and you have recovered from any associated injuries, your anesthesiologist will again attempt to wake you up for removal from the anesthesia machine. This is usually done by increasing the amount of oxygen flowing into your blood stream via a cannula or mask.
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Ventilation For More Than A Week
If your critically ill loved one has found themselves in the intensive care unit for over a week and has been under ventilation for over seven days, you may be worried. In a case where the intensive care team does not feel confident enough to remove the breathing tube after about a week, they may recommend a tracheostomy.
However, before they can suggest a tracheostomy, they should attempt to remove the patient from the induced coma first and if the patient is waking up and cooperating, the team should remove the tube. After removing the tube, they should try and find out if the patient can breathe comfortably without the use of the tube.
If this however fails, the team may then recommend a tracheostomy. This however, should not be an option until about 10 days of ventilation with a breathing tube has elapsed. It should also only be considered when the intensive care team is sure that there is no other viable alternative.
In addition to this, as far as tracheostomy is concerned in America, the inherent risk lies in the fact that the moment a tracheostomy is carried out, the ICU would want to send the patient to long-term assisted care. This may not be the desired outcome because LTAC is made in such a way as to cut costs and provide care of less acuity.
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Showering And Incision Care
You may shower if your surgeon has approved this prior to discharge. Your incisions may itch or feel sore, tight or numb for a few weeks. Some bruising around the incisions is also normal.
- Use warm water.
- You may wash your incisions gently with soap and water, but do not scrub them.
- Pat your incisions dry.
- Do not take baths or use powders or lotions near the incisions.
You may have white pieces of tape on your chest. These are called “steri strips”. They will gradually fall off. If they have not fallen off in 7 days, gently wash your chest with soap and water and gently peel them off. You may have some bleeding if the strips pulled off any scabs.
If you find it more comfortable, a thin layer of gauze may be placed over the incision. Women may wish to place cotton or soft material between the bra and chest wall.
- Your skin is sealed within 24-48 hours after surgery.
- You may itch or feel sore, tight or numb for a few weeks. Some bruising around the incision is also normal.
- Avoid sun exposure for the first year
- Chest tube drainage Within the first week after surgery, fluid may leak out from your chest tube sites. You may cover the sites with sterile bandages. Call your surgeon’s office if have to change the bandages more than once/day.
Signs of Possible Infection
- Increased swelling/tenderness along incision line
- Persistent high fever
How Is The Progress Of The Patient Monitored
Patients admitted to the intensive care unit are regularly observed to measure their heart rate, blood pressure, oxygen levels, and temperature. Other tests carried out include measuring the carbon dioxide and oxygen levels via a blood test. This is regularly reviewed by the ICU staff. When the patient wakes up, they are reassured and made to understand where they are and why.
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Preparing For The Surgery
Preparation for open heart surgery starts the night before. A person should eat an evening meal as usual but must not consume any food or drink after midnight.
It is a good idea to wear loose, comfortable clothing to assist with restricted movement following surgery, but wear whatever is comfortable.
Be sure to have all personal medical information on hand. This might include a list of medications, recent illness, and insurance information.
It is normal to feel anxious before an anesthetic, and people should not hesitate to seek reassurance from the healthcare team.
The doctor may request that the person washes their upper body with antibacterial soap. A member of the healthcare team may need to shave the persons chest area before they can have the anesthetic.
The doctors may also need to run tests before surgery, such as monitoring the heart or taking blood samples. A doctor or nurse might place a line into a vein to enable the delivery of fluids.
After the medical team has completed the preliminary tasks, the anesthesiologist will administer general anesthesia.
You May Experience Sleep Issues
Many people complain of having trouble sleeping for some time after heart surgery. You may experience insomnia because of:
Effects of anesthesia
Changes in your daily routine
Stress from personal concerns
Normal sleeping patterns typically return in two to three weeks. Until then, try these tips:
Take enough rest breaks in between your normal daily activities but avoid a daytime nap longer than 20 minutes.
If you have pain, take your pain medication about 30 minutes before bedtime.
Arrange the pillows so you can maintain a comfortable position and decrease muscle strain.
If you feel anxious or nervous, talk to your spouse, partner or a trusted friend. Get your troubles off your mind.
Avoid caffeine in the evenings.
Listen to relaxing music or a guided imagery audio program.
Ask your partner to give you a back rub.
Take a relaxing shower.
Follow a bedtime routine to let your body know its time to relax and get to sleep.
Its OK to sleep on your back, side or stomach. You will not hurt your incisions.
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What To Expect While You Recover In The Hospital
There are a full range of cardiac surgery procedures that repair and restore heart function. How long you stay in the hospital depends on the type of surgery you have.
Immediately after surgery, youll receive care in the hospitals intensive care unit . A care team of cardiac ICU specialists, respiratory therapists and nurses monitors you closely.
After two to three days, youll transition to intermediate care. Here youll begin physical and occupational therapy to help you transition to home. Youll learn how to move through daily tasks while protecting your incision and minimizing discomfort as you heal.
For standard open-heart surgery, youll stay in the hospital for five to seven days. You may need more time to recover after more complex surgery. After minimally invasive procedures, youll stay for one to three days.
Many patients continue their recovery at home. If you need additional therapy, your doctor may recommend care at a rehabilitation facility before returning home.
You may experience a variety of symptoms after heart surgery, including chest pain, constipation, muscle pain, loss of appetite, swelling and trouble sleeping. Medications can provide relief, which should improve over time.
After Heart Surgery Dos And Donts For Your Recovery
So, when will you be able to return to your normal routine? Again, the answer depends on the type of procedure you have. Your doctor will give you guidelines about any restrictions in your activity.
In general, you can resume your normal activities within one to two weeks after a minimally invasive heart procedure. For open-heart surgery, you can return to many activities within a month after surgery. Allow up to three months for proper recovery and healing.
Many patients can resume working in an office or home office setting a month after open-heart surgery. You may be able to return in one to two weeks after a minimally invasive procedure, says Dr. Tanaka. If your work requires more physical exertion, discuss restrictions with your care team.
To ensure the best long-term recovery after surgery, Dr. Tanaka recommends following these dos and donts.
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Ventilator Complications: Other Risks
Delirium: Youre usually unconscious or heavily sedated when youre on a ventilator. Either way, you take strong medications. Sometimes, these drugs may take some time to wear off even after the tube is removed from your airway.
You may have a hard time reading, writing, or thinking clearly. You also might notice a poor memory, have trouble sleeping, feel anxious, or have unusual emotions like paranoia. Talk to your doctor about these effects, which should fade over time.
Immobility: Because youre sedated, you dont move much when youre on a ventilator. That can lead to bedsores, which may turn into skin infections. Youre more likely to get blood clots for the same reason. Your muscles, including those that normally help you breathe for yourself, may get weak. You might need rehab with a physical or respiratory therapist.
Vocal cord problems: When your doctor removes the breathing tube to take you off the ventilator, it can damage your vocal cords. Expect some soreness and a raspy voice at first. But let your doctor know if its hard to breathe or speak after the tube comes out.
How Long Do They Keep You Sedated After Open Heart Surgery
You might be in this unit for one to three days. A prolonged stay does not imply that your CABG operation was a failure. It might signify that it is taking longer for your anaesthetic to wear off or for fluid in your chest to drain. You may experience a variety of feelings as you awaken. These include confusion, depression, anxiety and anger.
Many people are able to go home on the same day as their operation. Others will need more time to recover before they can leave the hospital. Everyone’s situation is different so it’s best to speak with members of your care team about how you feel after surgery.
If you are having problems breathing or feeling pain in your chest, let someone know immediately.
Do not drive until you have been released from the hospital. If you take medications like aspirin, blood thinners or warfarin , ask your doctor what actions to take if you must start them again after open heart surgery.
People who have had open heart surgery require careful monitoring by doctors after they leave the hospital. They are at risk for similar problems that led to their operation. For example, someone who has had a valve replacement might suffer serious bleeding if they bruise themselves. They should also avoid tasks that could cause them to lift heavy objects or exercise strenuously until they have healed.
Open heart surgery is a very important part of treating heart disease.
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