2012 OPEN FORUM Abstracts
PERIOPERATIVE USE OF AN ANESTHESIA VENTILATOR FOR AEROSOLIZED VASODILATOR: THE ROLE OF RESPIRATORY CARE.
Sherwin E. Morgan1, Katherine Mieure2, Valluvan Jeevanandam3, Frank Dupont4, Avery Tung5; 1Respiratory Care, University of Chicago, Chicago, IL; 2Pharmaceutical Services, University of Chicago, Chicago, IL; 3Cardio-Thoracic Surgery, University of Chicago, Chicago, IL; 4Anesthesia and Critical Care, University of Chicago, Chicago, IL; 5Anesthesia and Critical Care, University of Chicago, Chicago, IL
BACKGROUND: A small fraction of patients undergoing complex cardiac surgery are at risk for acute intraoperative right heart dysfunction. Current evidence suggests that aerosolized inhaled epoprostenol (Flolan® (PGE2) GlaxoSmithKline, Research Triangle Park, NC) is less expensive than nitric oxide and has similar efficiency for decreasing intraoperative pulmonary vascular resistance. METHOD; Perioperatively, both anesthesia staff and Respiratory Therapy require specialized training regarding the use of PGE2 with the anesthesia ventilator (Apollo®, Drager Medical, North America, Telford, PA) (AV). A vibrating mesh type of nebulizer, Aeroneb®, (Galway Business Park, Dangan, Galway, Ireland), (ANEB) kit and control unit is connected to the inspiratory port. One PALL® filter (PALL Medical, East Hills, NY) is then connected to the expiratory port and one disk filter is connected to the AV circuit to protect the AV gas analyzer. Four concentration based doses of PGE2 are used during therapy: 20,000 ng/mL, 10,000 ng/mL, 5,000 ng/mL, 2,500 ng/mL. Each is prepared as a salt based compound reconstituted in a glycine buffer diluent. Because the glycine buffer is sticky, AV performance is monitored closely for filter occlusion, inadvertent positive end expiratory pressure (auto-PEEP), end tidal CO2 (ETCO2) and tidal volume (VT). The PGE2 starting dose is 20,000 ng/mL, PGE2 is infused into the ANEB at a fixed 8 cc/hr rate. The ANEB control unit is set-up to run continuously. RESULTS: Perioperatively, we have safely treated more than 75 adult patients with PGE2 at The University of Chicago Medical Center. PGE2 is usually started toward the end of the case as cardiopulmonary bypass is being weaned. No intraoperative problems reported with regards to mean arterial pressure. No issues with regard to AV function, ETCO2 monitoring, measured VT, clogged filters or auto-PEEP reported during the intraoperative procedure. The use of other types of nebulizers utilize an external gas flow, which may have an effect on AV function and gas analyzer. CONCLUSION: Respiratory Therapy is an essential contributor in the safe administration of PGE2 during the perioperative period. PGE2 delivered by continuous ANEB is a safe effective substitute for nitric oxide. More prospective studies are needed to better determine optimal strategies for perioperative PGE2 delivery. Sponsored Research - None Apollo Ventilator with Aeroneb inline