Mechanical ventilation is a vital support associated with the treatment of patients with acute respiratory failure and in other indications such as surgery under general anesthesia, coma or shock. Optimization of settings during mechanical ventilation and implementation of protective ventilation help to avoid ventilation-induced injury, ensure adequate oxygenation and maintain adequate carbon dioxide concentration to avoid respiratory acidosis or alkalosis. Similarly, there is also no clear recommendation, to our knowledge, for the initial setting of the respiratory rate. Therefore, initial settings are not always adequate and in the literature the frequency of respiratory acidosis is very high, reaching about half of the patients receiving mechanical ventilation. VentilO, is an application that is available on smart phones. This educational application provides clinicians with initial settings and optimization of these settings based on gender, height, weight, body temperature and patient type. The algorithm used is based on published data regarding ventilatory requirements in different populations and the anatomical and instrumental dead space of patients. The purpose of our study is to: Assess whether ventilatory settings after intensive care unit admission after cardiac surgery are appropriate to compare the ventilatory adjustments made by clinicians with those proposed by the VentilO application.
Study Type
OBSERVATIONAL
Enrollment
100
This educational application provides clinicians with combinations of tidal volume and respiratory rate based on gender, height, weight, body temperature and patient type. The algorithm used is based on published data regarding ventilatory requirements in different populations (i.e. from intubated patients for scheduled surgery to the most severe ICU patients) and anatomical and instrumental dead space. The objective of this application is to help implement personalized protective ventilation in intubated patients according to their characteristics. After patient data entry in the VentilO application, the investigators will compare the recommended settings (for mechanical ventilation) vs the real clinician settings done by clinician after patient admission in ICU after cardiac surgery. The investigators will evaluated the potential effect of the VentilO recommendation on the first arterial (or capillary) blood gases compared to the real settings.
Institut Universitaire de Cardiologie et de Pneumologie de Québec
Québec, Quebec, Canada
acid-base abnormalities on arterial blood gases
Evaluate the frequency of acid-base abnormalities, either acidosis or alkalosis, of respiratory or mixed origin on the first arterial gases after intubation. Respiratory acidosis is defined as a pH \< 7.35 with a PaCO2 \> 45 mmHg, and respiratory alkalosis as a pH \> 7.45 with a PaCO2 \< 35 mmHg)
Time frame: On the first result available of arterial blood gases after intensive care unit admission; 1 hour maximum after intensive care admission
Occurence of optimal arterial blood gases result
An optimal arterial blood gases as defined by a pH between 7.35 and 7.45 with a PaCO2 between 36 and 45 mmHg
Time frame: On the first result available of arterial blood gases after intensive care unit admission; 1 hour maximum after intensive care admission
Severity of unbalance of arterial blood gases result
For acid-base abnormalities, they will be evaluated according to their level of severity: the frequency of moderate (pH between 7.30 and 7.34) and severe (pH \< 7.30) acidoses, and the frequency of moderate (pH between 7.46 and 7.50) and severe (pH \> 7.50) alkaloses. The frequency of moderate (PaCO2 between 46 and 50 mmHg) and severe (PaCO2 \> 50 mmHg) hypercapnia, and the frequency of moderate (PaCO2 between 31 and 35 mmHg) and severe (PaCO2 \< 31 mmHg) hypocapnia.
Time frame: On the first result available of arterial blood gases after intensive care unit admission; 1 hour maximum after intensive care admission
hemodynamic instabilities
Number of arterial hypotension requiring vascular filling \> 1000 ml and/or use of vasopressors or inotropes such as levophed or adrenaline at \> 0.05 mcg/kg/min)
Time frame: Between Hour0 to Hour1 after intensive care unit admission
ICU length of stay
ICU length of stay - ICU admission through ICU discharge
Time frame: up to 90 days. ICU stay - ICU admission through ICU discharge or until death if occured
Mechanical Ventilation duration
Time spent with invasive mechanical ventilation during ICU length of stay
Time frame: up to 90 days. ICU stay - ICU admission through ICU discharge or until death if occured
Acute renal failure
rate of acute renal failure during ICU length of stay. Renal failure will be defined according to the usual criteria, i.e., an increase of \>27 mmol/L creatinine in 48 hours or 1.5x over the preoperative baseline
Time frame: up to 90 days. ICU stay - ICU admission through ICU discharge or until death if occured
Hospital length of stay
Hospital length of stay - ICU admission through hospital discharge
Time frame: up to 90 days. ICU stay - ICU admission through ICU discharge or until death if occured
ICU mortality
Occurence of death during ICU stay
Time frame: up to 90 days. ICU admission through until death if occured
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