Perioperative Maintenance of Tissue Perfusion and Cardiac Output in Cardiac Surgery Patients

Lighthall, Geoffrey K.; Singh, Sumit

doi:10.1177/1089253214534781

Cited by 9 publications

(11 citation statements)

References 147 publications

(180 reference statements)

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“…23,62,64 Patients with cardiogenic shock might even be harmed by the increase in afterload and the coronary vasoconstriction. 65 In accordance with others, a maximum dose of 0,04 U/min is recommended. 5,23 Methylene blue prevents vasodilation by inhibiting soluble guanylyl cyclase and nitric oxide synthase activity.…”

Section: Maintain Perfusion Pressurementioning

confidence: 79%

Shock Management For Cardio-Surgical ICU Patients — The Golden Hours

Hauffe¹,

Krüger²,

Béttex³

et al. 2015

Cardiac Failure Review

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Shock in cardio-surgical intensive care unit (ICU) patients is a serious condition with a high morbidity and mortality.1,2 Prompt identification of the underlying conditions and correct management of the lifethreatening physiological deteriorations are crucial to save the patient's life. In daily practice, however, focusing on the main goal -to provide adequate oxygen delivery thereby preventing further organ damage -is often difficult due to multiple influences, distractions, and pending results. Hence, the setting up of priorities is necessary.In addition, many questions arise on how to optimally treat patients in shock: What blood pressure should we target? What fluid should we use and how much? Which vasoactive drug is best and which inotrope? While discussions about these issues can be very fruitful for experts, they risk confusing younger colleagues and nurses at the bedside. Disputes about controversial therapy opinions might consequently delay adequate resuscitation, putting the patient at risk of an adverse outcome. This review aims to give recommendations for the management during the early phase of shock of cardio-surgical patients hospitalised in the ICU. The focus is on the first 6 hours, which are also called 'the golden hours'. Methods Clinical SettingThe cardio-surgical ICU at the University Hospital Zurich is a 12-bed, high-intensity unit that cares for more than 1,100 patients every year.The majority of these critically ill patients undergo cardiac and/or major vascular surgery, most of them being mechanically ventilated and on inotrope/vasopressor support. The unit is part of a successful heart failure programme that includes extracorporeal life support, ventricular assist devices and a heart transplantation service. In order to optimise the initial resuscitation of patients and to avoid adverse effects of inadequate treatment, the consultants of the unit have agreed on treatment recommendations, which are presented here.They are based on current evidence and complemented by clinical experience in areas of uncertainty. Data ExtractionFor this narrative review, a search of the PubMed database and a review of bibliographies from selected articles were performed to identify original data relating to this topic. Key words used for the search were 'shock', 'cardiac surgery', 'critical care', 'inotropes', 'inotropic therapy', 'circulatory support', 'cardiogenic shock' and 'sepsis'. National and international guidelines were reviewed and integrated, e.g. The 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation, 3 The 2014 ESC/ EACTS guidelines on myocardial revascularization 4 and The Surviving Sepsis Campaign guidelines 5 . Articles were scrutinised regarding their study design, population evaluated, interventions, outcomes, and limitations. Finally, personal recommendations were included and highlighted as such to give a comprehensive overview on this topic. Rationale for an Early Management of ShockShock in patients under...

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Section: Maintain Perfusion Pressurementioning

confidence: 79%

Shock Management For Cardio-Surgical ICU Patients — The Golden Hours

Hauffe¹,

Krüger²,

Béttex³

et al. 2015

Cardiac Failure Review

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“…25 ECLS with an extracorporeal membrane oxygenator can be established quickly in experienced hands and offers an opportunity for temporary haemodynamic support. 26 This might give time for decision-making (bridge to decision) or for the ventricle to recover (bridge to recovery).…”

Section: Evaluate Mechanical Supportmentioning

confidence: 99%

“…Therefore, RV function must be assessed before considering the implantation of a LVAD. 25 Surely the decision should be made in a multidisciplinary approach by experts due to the invasive nature of these devices. Complications may be related to the mandatory use of anticoagulation (bleeding, thromboembolism), mechanical shear stress on cellular blood components (haemolysis) and long-term infections of the implanted materials (drive line, cannulas, device).…”

Section: Evaluate Mechanical Supportmentioning

confidence: 99%

“…Complications may be related to the mandatory use of anticoagulation (bleeding, thromboembolism), mechanical shear stress on cellular blood components (haemolysis) and long-term infections of the implanted materials (drive line, cannulas, device). 25,26,[29][30][31][32][33] A summary of the advantages and risks of ECLS is provided in Table 2.…”

Section: Evaluate Mechanical Supportmentioning

confidence: 99%

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Shock Management for Cardio-surgical Intensive Care Unit Patient: The Silver Days

Hauffe¹,

Krüger²,

Béttex³

et al. 2016

Cardiac Failure Review

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Shock in cardio-surgical intensive care unit (ICU) patients requires prompt identification of the underlying condition and timely therapeutic interventions. Management during the first 6 hours, also referred to as “the golden hours”, is of paramount importance to reverse the shock state and improve the patient’s outcome. The authors have previously described a state-of-the-art diagnostic work-up and discussed how to optimise preload, vascular tone, contractility, heart rate and oxygen delivery during this phase. Ideally, shock can be reversed during this initial period. However, some patients might have developed multiple organ dysfunction, which persists beyond the first 6 hours despite the early haemodynamic treatment goals having been accomplished. This period, also referred to as “the silver days”, is the focus of this review. The authors discuss how to reduce vasopressor load and how to minimise adrenergic stress by using alternative inotropes, extracorporeal life-support and short acting beta-blockers. The review incorporates data on fluid weaning, safe ventilation, daily interruption of sedation, delirium management and early rehabilitation. It includes practical recommendations in areas where the evidence is scarce or controversial. Although the focus is on cardio-surgery ICU patients, most of the considerations apply to critical ill patients in general.

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“…9 Ideally, the patient is resuscitated to these endpoints in the operating room. Mean pressures in the range of 65 to 90 and cardiac indices (CI) >2.5 L/min/m 2 are generally considered desirable and will permit successful extubation.…”

Section: Hemodynamicsmentioning

confidence: 99%

Routine Postoperative Care of Patients Undergoing Coronary Artery Bypass Grafting on Cardiopulmonary Bypass

Lighthall

Olejniczak

2015

Semin Cardiothorac Vasc Anesth

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The postoperative course of a patient undergoing cardiac surgery (CS) is dictated by a largely predictable set of interactions between disease-specific and therapeutic factors. ICU personnel need to quickly develop a detailed understanding of the patient's current status and how critical care resources can be used to promote further recovery and eventual independence from external support. The goal of this article is to describe a typical operative and postoperative course, with emphasis on the latter, and the diagnostic and therapeutic options necessary for the proper care of these patients. This paper will focus on coronary artery bypass grafting as a model for understanding the course of CS patients; however, many of the principles discussed are applicable to most cardiac surgery patients.

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Perioperative Maintenance of Tissue Perfusion and Cardiac Output in Cardiac Surgery Patients

Cited by 9 publications

References 147 publications

Shock Management For Cardio-Surgical ICU Patients — The Golden Hours

Shock Management For Cardio-Surgical ICU Patients — The Golden Hours

Shock Management for Cardio-surgical Intensive Care Unit Patient: The Silver Days

Routine Postoperative Care of Patients Undergoing Coronary Artery Bypass Grafting on Cardiopulmonary Bypass

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