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Effect of Continuous Epidural Block on the Duration of Intensive Care after Cardiac Surgery
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Choon Soo Lee, Jung Uk Han, Tae Jung Kim, Chong Kweon Chung, Hyun Kyung Lim, Young Deog Cha, Hey Ran Shin
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Korean J Crit Care Med. 2000;15(1):41-46.
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 Abstract
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- BACKGROUND
Continuous epidural block after surgery has been able to get better postoperative analgesic effect than intermittent intravenous (IV) opioids and to decrease the duration of mechanical ventilatory support, endotracheal intubation and ICU stay. The purpose of this study is to observe these effects of continuous epidural block after cardiac surgery.
METHODS
30 patients, undergoing cardiac surgery, were divided into 2 groups. Postoperative analgesia were performed by intermittent IV meperidine 25 mg in group 1 and by continuous epidural block with 1% mepivacaine 100 ml and morphine 4 mg in group 2. Both groups were supplemented, at the patient's request, by IV meperidine 25 mg as needed.
Quality of pain relief, total number of IV meperidine and duration of consciousness return, mechanical ventilatory support, endotracheal intubation, ICU stay were compared between 2 groups.
RESULTS
Quality of pain relief and total number of IV meperidine were significantly lower in group 2 than group 1, each time interval. Duration of consciousness return, mechanical ventilatory support, endotracheal intubation, ICU stay and time interval between consciousness return & mechanical ventilatory support were significantly shorter in group 2 than group 1.
CONCLUSIONS
Continuous epidural block, with 1% mepivacaine 100 ml and morphine 4 mg, for postoperative analgesia decreases the duration of intensive care compaered with intermittent IV meperidine 25 mg, after cardiac surgery.
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Comparison of Initial Weaning Success Rates and Weaning Periods between Synchronized Intermittent Mandatory Ventilation and Pressure Support Ventilation
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Joong Hyuk Yang, Kyoung Min Lee, Hyun Kyung Lim, Dae Ja Um, Ryung Choi
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Korean J Crit Care Med. 1997;12(1):31-36.
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Abstract
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- BACKGOUND: SIMV (synchronized intermittent mandatory ventilation) mode is comprised of a ventilator that intermittently enters the volume assist/control mode in conjunction with circuitry that allows for spontaneous ventilation by a demand flow system. There is additional work of breathing caused by the endotracheal tube and demand valve in SIMV. However, PSV (pressure support ventilation) has the ability to decrease work of breathing and to augment spontaneous breaths with a variable amount of inspiratory positive pressure with a clinician-selected level of inspiratory airway pressure.
METHODS
To compare the initial weaning success rates and weaning periods between SIMV and PSV, we reviewed medical records of 103 intensive care unit patients, who had received mechanical ventilatory support and performed weaning. We compared the patients' characteristics, initial weaning success rates and ventilatory periods, weaning periods, weaning periods/ventilatory periods, ICU stays according to the weaning process (SIMV and PSV). And then we compared the same variables as the above between the initial weaning success group and initial weaning failure group.
RESULTS
Patients' characteristics, ventilatory periods, weaning periods, ICU stays were similar, but there was significantly shorter weaning periods/ventilatory periods on PSV group. Initial weaning success rates according to the weaning process were similar. Ventilatory periods, weaning periods, weaning periods/ventilatory periods, ICU stays were significantly shorter on initial weaning success group.
CONCLUSIONS
PSV could be used effectively as one of the weaning modes, and further studies are required about weaning criteria, weaning start time and weaning methods.
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