Loretha underwent the procedure with no complications and was transferred to the cardiovascular recovery room in stable condition. She remained intubated on the first day recieving F102 at 60%. She had two chest tubes. One put out 130 and the other put out 10. She was on Cardene drip as well as a nitroglycerin and Nitpride drip. She was allowed to wake up, and she was able to be alert. On postoperative day one, patient was able to be weaned off the vasodilators and the sedation. Her maximum temperature reached 101.1 degrees F. and she was able to be extubated on the morning of Sept. 12th. The cerebrospinal fluid drain was clamped that day, and the pulmonary artery catheter was removed. Later on that day after the patient's CSF drain was discontinued and Swan-Ganz removed, the patient had to be re-intubated due to respiratory insufficiency. She also was in afib, and this was controlled with weight-controlled Metoprolol. She also had hypotention that responded to a fluid bolus. On post operative day #2, patient was hemodynamically stable, was intubated on SIMV with F102 of 60%, the JP and one of the chest tubes were removed. On Sept. 13th, the patient had a temporary episode of bilateral leg weakness and then paralysis. The patient was given Mannitol and other measurements like increasing the oxygen to treat the spinal ischemia. Eventually she was able to recover her motor function in both extremities. She continued to be hemodynamically stable, and on Sept. 14th,the patient still remained intubated with P102 of 100%, hemodynamically stable with good urine output. The x-ray showed opacities in the left lung consistent with compression and possible pneumonia. On postoperative days #4 and #5 the patient remained hemodynamically stable with a stable H and H and with a good urine output and a good creatinine. The CSF that had been previously clamped was clamped and then reopened for management of the spinal ischemia was once again clamped on postoperative day #4. The On-Q pumps were discontinued, and the chest tube was removed. She continued to have pulmonary problems with a left sided contusion and possible pneumonia. The ABG showed an increased alveolar arterial gradient, and because of this extubation was postponed. On Sept 16th, at 11:00, the CSF drain was removed without complications. On postoperative days #7 and #8, the patient remained hemodynamically stable. The patient's F102 was weaned off to 40%. She had some anxiety overnight, and this was managed with Avitan. On Sept 18th, the patient was placed on CPAP and was started on tube feedings as well as Lovenox. On Sept. 19th, patient continued to be hemodynamically stable with a good urine output and a stable creatinine of 0.7. Patient was febrile with a temperature of 101.5. heart rate of 80's and 100's, blood pressure systolic between 90's and 140's anddiastolic between 60's and 70's. She was on CPAP at 40%, and her white count was 18.2. Vancomycin and Zosyn were started on the previous day for treatment of ventilator-associated pneumonia. A pic line was placed, and the right internal jugular catheter was discontinued. The PICC line technician was not able to go ahead and place the central venous catheter, and because of this decision was made to place a left subclavian triple lumen which was placed without complications on Sept. 20 at 7:00 AM. The next day, the patient continued to do well with regard to her hemodynamic status. Nevertheless, she continued to be febrile with 101.8 temperature and a white count of 17,000. On Sept. 21st, the patient was stable on CPAP with an F102 of 40%. Blood gas had a PA02 of 90 and an oxygen saturation of 97.6%. Hemodynamically the patient remained stable with Metoprolol. As far as her infectious status, the patient continued to be febrile and had a white count of 20.9. The patient continued to be on Vancomycin and Zosyn, and the cultures showed MRSA. On Sept. 22nd, the patient continued to be on CPAP and continued to have ventilator-associated pneumonia with a white count of 16 and no change in the x-ray. She continued to be managed with Vancomycin for MRSA pneumonia, and she continued to be hemodynamically stable.
