Despite hemodynamic support with IABP and initiation of Dobutamine/ Norepinephrine infusion, the patient’s shortness-of-breath/ work-of-breathing fails to improve significantly. CXR reveals diffuse bilateral infiltrates consistent with pulmonary edema. Preparations are made for emergent intubation, but the intensivist opts for non-invasive ventilation with BiPap. The patient tolerates BiPap well despite a transient increase in his norepinephrine requirements, and diuresed 2L of urine after a dose of 40mg IV Furosemide, with subsequent improvement in his work-of-breathing. The patient is taken by the CT surgery team for CABG x 5 the following morning, and is weaned from mechanical support and inotropes/ vasopressors over the following two days. Prior to discharge, the cardiology team, psychiatry, nurse case manager, and the patient’s family are engaged in a multidisciplinary meeting regarding smoking cessation and adherence to prescribed medical therapy s/p CABG. 1.) While intubation is a lifesaving procedure, what complications of intubation could be anticipated in this patient’s case? 2.) What hemodynamic and laboratory parameters should the RN trend in order to determine the patient’s response to therapy.
[Verified Answer]: Despite hemodynamic support with IABP and…
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