Cardiac Tamponade..Induction,Intubation,and Mechanical ventilation

Positive-pressure ventilation (e.g., mechanical ventilation) increases intrathoracic pressure potentially reducing venous return, right-ventricular filling, and cardiac output.

Pericardial tamponade similarly causes hemodynamic compromise through increased pericardial pressure which reduces right-ventricular filling and cardiac output.

When mechanically ventilating a patient with known or suspected pericardial tamponade the mechanisms above may be additive, causing cardiovascular collapse and possibly PEA arrest.

For the patient with known or suspected pericardial tamponade consider draining the pericardial effusion prior to intubation or delaying intubation until absolutely necessary.

If intubation is unavoidable,Ketamine is the ideal agent for induction ,remember the two" F'' of cardiac tamponade ,Fast and Full Heart.

Then consider maintaining the intrathoracic pressure as low as possible (by keeping the PEEP and tidal volumes to a minimum) to ensure adequate cardiac filling and cardiac output.Some recommend to keep patient spontaneous breathing after intubation

References

Ho, A. et. al. Timing of tracheal intubation in traumatic cardiac tamponade: A word of caution. Resuscitation, 80(2), 272–274.

Comments

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