Echocardiography in post-cardiac surgery

2020 ◽  
pp. 301-310
Author(s):  
Susanna Price
Keyword(s):  
Cardiac Surgery ◽  
Transoesophageal Echocardiography ◽  
Cardiac Surgical Procedures ◽  
Surgical Patient ◽  
Cardiac Surgical Patient ◽  
Critical Care Echocardiography ◽  
Anatomy And Physiology ◽  
Cardiac Intensive Care ◽  
Extracorporeal Support ◽  
Post Cardiac Surgery

Echocardiography following cardiac surgery can be regarded as a subspecialty of critical care echocardiography, as it requires knowledge of the specifics of each surgical intervention and potential complications, as well as in-depth knowledge of cardiac anatomy and physiology. It has a significant overlap with intraoperative transoesophageal echocardiography (TOE) but they are not synonymous. This chapter outlines the general approach to evaluate the postoperative cardiac surgical patient using echocardiography, as well as specific considerations for common cardiac surgical procedures, and some of the potential pitfalls that exist. As there are increasing numbers of transcatheter/hybrid interventions now being undertaken, this chapter additionally includes a section on postcatheter complications. The final section addresses areas where echocardiography can be used to guide the use of extracorporeal support on the surgical cardiac intensive care unit.

Epidemiology of Cardiac Surgery and the Cardiac Surgical Patient

2019 ◽  
pp. 266-280
Author(s):  
Jason Neil Katz ◽  
Edward J. Sawey
Keyword(s):  
Critical Care ◽  
Cardiac Surgery ◽  
Postoperative Care ◽  
Clinical Skill ◽  
Surgical Patient ◽  
Cardiac Surgical Patient ◽  
Historical Events ◽  
Multidisciplinary Collaboration ◽  
Skill Sets ◽  
Patient Demographics

While the timeline has been relatively abbreviated, there has been significant evolution in the field of cardiac surgery. These changes have been driven by a combination of operative innovation, changing patient demographics, and novel critical care resources, all of which have allowed today's surgeons to treat a myriad of conditions among increasingly higher risk patient cohorts. At the same time, this has forced providers to expand their clinical skill sets, embrace multidisciplinary collaboration, enhance postoperative care, and intensify the rigor by which outcomes and quality are being measured. In spite of this increasing complexity, however, mortality in cardiac surgery continues to improve. In this chapter, we highlight key historical events and describe an unprecedented trajectory and evolution in care practices that have helped shape modern cardiac surgery. We also make an appeal for additional research efforts which are needed to ensure sustained and innovative growth.

The edinburgh cardiac surgery score survival prediction in the long-stay ICU cardiac surgical patient

1995 ◽  
Vol 9 (8) ◽  
pp. 419-425 ◽  
Author(s):  
M THOMPSON ◽  
R ELTON ◽  
K STURGEON ◽  
S MANCLARK ◽  
A FRASER ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Surgical Patient ◽  
Survival Prediction ◽  
Cardiac Surgical Patient

scholarly journals Haemorrhagic peritonitis as a late complication of echocardiography guided pericardiocentesis

Heart ◽  
2004 ◽  
Vol 90 (3) ◽  
pp. e16-e16 ◽  
Author(s):  
H Luckraz ◽  
S Kitchlu ◽  
A Youhana
Keyword(s):  
Cardiac Surgery ◽  
Pericardial Effusion ◽  
Late Complication ◽  
Surgical Patient ◽  
General Anaesthetic ◽  
Safe Procedure ◽  
Cardiac Surgical Patient ◽  
Clinically Significant ◽  
Uncommon Complication

Clinically significant pericardial effusion is an uncommon complication after cardiac surgery. Pericardiocentesis can be performed either through a mini-sternotomy or under echocardiography guidance. Echocardiography guidance is a relatively safe procedure and it avoids the need for another general anaesthetic. However, in this post cardiac surgical patient echocardiography guided pericardiocentesis was complicated several days later by haemorrhagic peritonitis.

Delayed Development of Malignant Hyperthermia Following Cardiopulmonary Bypass

2017 ◽  
Vol 22 (1) ◽  
pp. 95-99 ◽  
Author(s):  
Stephen Hall Sams ◽  
Stephen Revilla ◽  
David Lawrence Stahl
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Malignant Hyperthermia ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Signs And Symptoms ◽  
Life Threatening ◽  
Cardiac Intensive Care ◽  
High Index Of Suspicion ◽  
Post Cardiac Surgery

Malignant hyperthermia (MH) is a rare but potentially life-threatening disorder encountered during general anesthesia. The use of cardiopulmonary bypass during cardiac surgery can obscure many of the cardinal signs and symptoms of MH. The development of postoperative MH following cardiac surgery is rare, but anesthesiologists and intensivists must maintain a high index of suspicion in order to make a prompt diagnosis. Initiation and tailored maintenance of MH therapy must also consider the complex physiologic changes of patients in the immediate post–cardiac surgery period. In this article, we present a case of the development of postoperative MH in the cardiac intensive care unit after elective open heart surgery with cardiopulmonary bypass.

scholarly journals Use of Continuous Infusion Hydralazine in a Pediatric Patient on Mechanical Circulatory Support

2016 ◽  
Vol 21 (3) ◽  
pp. 252-255
Author(s):  
Nicholas O. Dillman ◽  
Marc M. Anders ◽  
Brady S. Moffett
Keyword(s):  
Cardiac Surgery ◽  
Continuous Infusion ◽  
Bolus Dose ◽  
Circulatory Support ◽  
Acute Hypertension ◽  
Afterload Reduction ◽  
Sustained Reduction ◽  
Peripheral Arterial ◽  
Extracorporeal Support ◽  
Post Cardiac Surgery

Hydralazine is a direct peripheral arterial vasodilator used for acute hypertension. Usually administered as a bolus dose, continuous infusion has been described during pregnancy for preeclampsia and eclampsia and in limited reports in cardiac surgeries for afterload reduction. This case describes the use of continuous infusion hydralazine for afterload reduction in an infant receiving extracorporeal membrane oxygenation (ECMO) post–cardiac surgery. Postsurgery, the patient's mean arterial pressures (MAPs) could not be controlled despite escalating doses of vasodilatory medications including nitroprusside, nicardipine, and milrinone; hence, continuous infusion hydralazine was initiated. Although the initiation of a hydralazine infusion produced a decrease in MAP, the response was unsustainable. This case highlights an alternative method for managing systemic vascular resistance and cardiac output to allow for myocardial recovery after cardiac surgery and use of extracorporeal support. At the time of this writing, this is the first published case describing hydralazine administration via continuous infusion in pediatric patients. The use of continuous infusion hydralazine for afterload reduction provided a brief, non-sustained reduction in MAP in a post–cardiac surgery infant managed on ECMO support.

Epidemiology of Cardiac Surgery and the Cardiac Surgical Patient

2015 ◽  
pp. 1-15
Author(s):  
Jason Neil Katz ◽  
Edward J. Sawey
Keyword(s):  
Critical Care ◽  
Cardiac Surgery ◽  
Postoperative Care ◽  
Clinical Skill ◽  
Surgical Patient ◽  
Cardiac Surgical Patient ◽  
Historical Events ◽  
Multidisciplinary Collaboration ◽  
Skill Sets ◽  
Patient Demographics

While the timeline has been relatively abbreviated, there has been significant evolution in the field of cardiac surgery. These changes have been driven by a combination of operative innovation, changing patient demographics, and novel critical care resources, all of which have allowed today's surgeons to treat a myriad of conditions among increasingly higher risk patient cohorts. At the same time, this has forced providers to expand their clinical skill sets, embrace multidisciplinary collaboration, enhance postoperative care, and intensify the rigor by which outcomes and quality are being measured. In spite of this increasing complexity, however, mortality in cardiac surgery continues to improve. In this chapter, we highlight key historical events and describe an unprecedented trajectory and evolution in care practices that have helped shape modern cardiac surgery. We also make an appeal for additional research efforts which are needed to ensure sustained and innovative growth.

scholarly journals Cost of treating ventilator-associated pneumonia post cardiac surgery in the National Health Service: Results from a propensity-matched cohort study

2017 ◽  
Vol 19 (2) ◽  
pp. 94-100 ◽  
Author(s):  
Heyman Luckraz ◽  
Na’ngono Manga ◽  
Eshan L Senanayake ◽  
Mahmoud Abdelaziz ◽  
Shameer Gopal ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
National Health Service ◽  
Ventilator Associated Pneumonia ◽  
Significant Morbidity ◽  
Cardiac Intensive Care Unit ◽  
Cardiac Intensive Care ◽  
The Cost ◽  
Post Cardiac Surgery

Background Ventilator-associated pneumonia is associated with significant morbidity, mortality and healthcare costs. Most of the cost data that are available relate to general intensive care patients in privately remunerated institutions. This study assessed the cost of managing ventilator-associated pneumonia in a cardiac intensive care unit in the National Health Service in the United Kingdom. Methods Propensity-matched study of prospectively collected data from the cardiac surgical database between April 2011 and December 2014 in all patients undergoing cardiac surgery (n = 3416). Patients who were diagnosed as developing ventilator-associated pneumonia, as per the surveillance definition for ventilator-associated pneumonia (n = 338), were propensity score matched with those who did not (n = 338). Costs of treating post-op cardiac surgery patients in intensive care and cost difference if ventilator-associated pneumonia occurred based on Healthcare Resource Group categories were assessed. Secondary outcomes included differences in morbidity, mortality and cardiac intensive care unit and in-hospital length of stay. Results There were no significant differences in the pre-operative characteristics or procedures between the groups. Ventilator-associated pneumonia developed in 10% of post-cardiac surgery patients. Post-operatively, the ventilator-associated pneumonia group required longer ventilation (p < 0.01), more respiratory support, longer cardiac intensive care unit (8 vs 3, p < 0.001) and in-hospital stay (16 vs 9) days. The overall cost for post-operative recovery after cardiac surgery for ventilator-associated pneumonia patients was £15,124 compared to £6295 for non-ventilator-associated pneumonia (p < 0.01). The additional cost of treating patients with ventilator-associated pneumonia was £8829. Conclusion Ventilator-associated pneumonia was associated with significant morbidity to the patients, generating significant costs. This cost was nearer to the lower end for the cost for general intensive care unit patients in privately reimbursed systems.

Analysis of Nosocomial Infections in Post–Cardiac Surgery Extracorporeal Membrane Oxygenation Support Therapy

2018 ◽  
Vol 21 (5) ◽  
pp. E387-E391 ◽  
Author(s):  
Binfei Li ◽  
Geqin Sun ◽  
Zhou Cheng ◽  
Chuangchuang Mei ◽  
Xiaozu Liao ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Stay ◽  
Nosocomial Infections ◽  
Total Hospital ◽  
Secondary Infections ◽  
Total Hospital Stay ◽  
Mechanical Ventilation Time ◽  
Post Cardiac Surgery

Objectives: This study aims to analyze the nosocomial infection factors in post–cardiac surgery extracorporeal membrane oxygenation (ECMO) supportive treatment (pCS-ECMO). Methods: The clinical data of the pCS-ECMO patients who obtained nosocomial infections (NI) were collected and analyzed retrospectively. Among the 74 pCS-ECMO patients, 30 occurred with NI, accounting for 40.5%; a total of 38 pathogens were isolated, including 22 strains of Gram-negative bacteria (57.9%), 15 strains of Gram-positive bacteria (39.5%), and 1 fungus (2.6%). Results: Multidrug-resistant strains were highly concentrated, among which Acinetobacter baumannii and various coagulase-negative staphylococci were the main types; NI was related to mechanical ventilation time, intensive care unit (ICU) residence, ECMO duration, and total hospital stay, and the differences were statistically significant (P < .05). The binary logistic regression analysis indicated that ECMO duration was a potential independent risk factor (OR = 0.992, P = .045, 95.0% CI = 0.984-1.000). Conclusions: There existed significant correlations between the secondary infections of pCS-ECMO and mechanical ventilation time, ICU residence, ECMO duration, and total hospital stay; therefore, hospitals should prepare appropriate preventive measures to reduce the incidence of ECMO secondary infections.

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