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    Weaning From IABP

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    drjigneshnhl
    The document discusses weaning from intra-aortic balloon pumps (IABP). Traditionally, weaning is done by reducing the assist rate from 1:1 to 1:2. However, a new method involves decreasing augmentation while keeping the rate at 1:1. Weaning should be gradual over a preset time interval in two phases. Criteria for initiating weaning include satisfactory left ventricular performance and a patient in hemodynamic class I. The goal is to ensure cardiac function without IABP assistance.

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    Weaning From IABP

    Uploaded by

    drjigneshnhl
    2K views22 pages
    The document discusses weaning from intra-aortic balloon pumps (IABP). Traditionally, weaning is done by reducing the assist rate from 1:1 to 1:2. However, a new method involves decreasing augmentation while keeping the rate at 1:1. Weaning should be gradual over a preset time interval in two phases. Criteria for initiating weaning include satisfactory left ventricular performance and a patient in hemodynamic class I. The goal is to ensure cardiac function without IABP assistance.

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    HOW TO WEAN FROM IABP

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    The document discusses weaning from intra-aortic balloon pumps (IABP). Traditionally, weaning is done by reducing the assist rate from 1:1 to 1:2. However, a new method involves decreasing augmentation while keeping the rate at 1:1. Weaning should be gradual over a preset time interval in two phases. Criteria for initiating weaning include satisfactory left ventricular performance and a patient in hemodynamic class I. The goal is to ensure cardiac function without IABP assistance.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    2K views22 pages

    Weaning From IABP

    Uploaded by

    drjigneshnhl
    The document discusses weaning from intra-aortic balloon pumps (IABP). Traditionally, weaning is done by reducing the assist rate from 1:1 to 1:2. However, a new method involves decreasing augmentation while keeping the rate at 1:1. Weaning should be gradual over a preset time interval in two phases. Criteria for initiating weaning include satisfactory left ventricular performance and a patient in hemodynamic class I. The goal is to ensure cardiac function without IABP assistance.

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    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 22

    Weaning From IABP

     Ri 王昭閎
    IntraAortic Balloon Pump

    Settings: catheter-mounted,
    balloon volume 30-50 ml, central
    lumen, helium, synchronization.
    Net effect: myocardial oxygen
    supply/demand ratio with a small
    increase in systemic perfusion
    (≦0.5L/min)
    Timing: Pre-,Peri-,Post-op
    IABP Waveforms
    IABP Waveforms

    Early Inflation Late Inflation


    IABP Waveforms

    Early Deflation Late Deflation


    Indications
     Cardiogenic shock
     Mechanical complication of AMI
     In association with CABG
     In association with nonsurgical revascularization
     Stabilization of cardiac transplant recipient
    before insertion of ventricular assist device
     Postinfarction angina
     Ventricular arrhythmias related to ischemia
    Contraindications
     Absolute Contraindications
     Aortic valve insufficiency; Aortic dissection
     Relative Contraindications
     Femoral arterial insertion: Abdominal aortic
    aneurysm; Severe calcific aortoiliac or femoral
    arterial disease

    Percutaneous insertion: Recent ipsilateral
    groin incision; Morbid obesity
    Complications
     Complication rate: 5-47%
     Limb ischemia; aortic dissection; aortoiliac
    laceration; perforation; deep wound
    infection
     Bleeding at insertion site; superficial
    wound infections; asymptomatic loss of
    peripheral pulse; lymphocele
    Weaning from IABP
     Continued satisfactory LV performance
     Augmentation curve remains < SBP
     No further increase in CO at 1:1 assist rate in
    comparinson with 1:2
    Weaning from IABP
     No experimental or clinical studies have
    been done to evaluate the most effective
    weaning
     Traditional method: reduce the assist rate
    from 1:1 to 1:2, etc, because all consoles
    are equipped with it.
     The method of weaning is, at best,
    selected arbitrarily.
    Weaning from IABP
     Traditional method:↓Assist rate while maintaining
    augmentation.
     New method: ↓Augmentation while rate at 1:1
     Goal: assure satisfactory cardiac performance
    independent of balloon pump assist.
     Weaning is done in a gradual fashion over a
    preset time interval (in two phases)
     Criteria for initiation of IABP weaning: a patient
    must be in hemodynamic class I (Shock box)
    Weaning from IABP
    Shock Box
     Left Ventricular Stroke Work
    Index
     LVSWI = (SV/BSA)*(MAP-
    PCWP)*(0.0136)
     Normal = 45-75
     Class I: Minimal failure group
     Class II: Hypovolemic group
     Class III: Hypervolemic-
    Hyperdynamic group
     Class IV: Classic cardiogenic
    shock (Hypervolemic-
    Hypodynamic group)
    Protocols

     Initial set of hemodynamic data


     Phase I: 1:2 + 100% V.S. 75% + 1:1
     Appropriate therapeutic measure
     Parameters:↓LVSWI or↑PWP > 20%
     If not class I, 1:1 + 100% for more 12-24 hr
     Phase II: 1:3 + 100% V.S. 50% + 1:1
     Flutter mode (<25%) for 10-15 min; Prevent clot
     Augmentation(%) adjustment by pressure;
    variable balloon volume changes
    Results

     75% + 1:1 similar to 1:2 + 100%


     Class I p’t in Phase II: min. change between phases
     Phase II as balloon “off” or “flutter”
     Combined methods is safe and reliable
     IABP < 3-4 hrs, weaning may be shortened to 1-2 hrs
     Average time from class IV to I: 48 hrs
    One Patient’s Data
    Criteria for Variant Condition

     Preoperatively or acute ventricular dysfunction


     ~1 hr devided into two 30-minute phases
    Criteria for Variant Condition

     Emergency basis (at the completion of a cardiac


    operation),
     IABP should not be DC early after satisfactory response
     Maybe 12-18 hours later in ICU
    Criteria for Variant Condition
    Weaning in Special Situations
     Prolonged Respiratory Support
     Never weaning simultaneously
     DC respiratory support first, if possible

    12-24 hr later, weaning may be attempted

    COPD or ARDS, IABP may be weaned first
     Pressor Therapy
     Vasopressor to the lowest level before weaning
     Exception: Leg ischemia. Early removal or change site
     Change all the pressor drugs to dopamine or dobutamine
     Decrease to <5mcg/kg/min, then weaning
     Within 12-24 hr after DC IABP, decrease in conc. and DC
     DC pressor but keep IABP as bridge to trans.
    Thanks for Your Attention
    References
     Clinical Application of Intra-Aortic
    Balloon Pump, Third Edition.
    Hooshang Bolooki.
     Counterpulsation: historical
    background, technical
    improvements, hemodynamic and
    metabolic effects," which appears
    in Volume 84 (1994) of the journal
    Cardiology (pp. 156-167).
     Braunwald: Heart Disease: A
    Textbook of Cardiovascular
    Medicine, 6th ed.

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