Houston Methodist, Houston, Texas, US.
Methodist Debakey Cardiovasc J. 2023 Aug 1;19(4):97-99. doi: 10.14797/mdcvj.1274. eCollection 2023.
Cardiac surgery is quite common in the United States. Outcomes after cardiac surgery are not only dependent on how the surgery went and how the anesthesia care was provided intraoperatively but also on the optimal management in the postoperative critical care setting. It is of paramount importance that the cardiac intensivist has a comprehensive understanding of cardiopulmonary physiology and the sequelae of cardiopulmonary bypass. Most preventable deaths after cardiac surgery have been linked to postoperative problems in the intensive care unit (ICU). Failure to recognize and rescue a patient from potentially reversible complications is a cause of perioperative morbidity and mortality. Patients who undergo cardiac surgery often present with multiple rapidly changing clinical problems; they are initially unstable with extremely fluid and dynamic clinical status. Postoperative care of these patients requires knowledge of general fundamental concepts of patient care as well as concepts unique to this set of patients. The initial management of these patients as they return from the operating room is critical, because clinical errors at this time can have far-reaching implications. The initial management should begin even before the patient arrives in the cardiovascular intensive care unit (CVICU). It is vital that the cardiac intensivist reviews the chart and notes the type of surgery, indications, preoperative hemodynamic data, comorbid conditions, medications, and allergies. Upon the patient's arrival in the CVICU, a careful systematic assessment of the patient begins with obtaining a comprehensive handoff from the surgical and anesthesia team. The cardiac intensivist should ascertain what procedure was done in the operating room and inquire as to any intraoperative events that might impact the patient's postoperative course. Then, they should physically examine the patient as part of this initial evaluation. During the initial assessment, the intensivist should avoid focusing on any one issue and attempt to get a global picture of the patient's clinical status. A thorough knowledge of the specific monitoring and drug delivery lines is imperative, as is knowledge of where the drains are placed. Once the initial assessment is complete, specific issues can be identified, prioritized, and addressed..
心脏手术在美国相当常见。心脏手术后的结果不仅取决于手术的进行情况和术中麻醉护理的提供情况，还取决于术后重症监护环境中的最佳管理。至关重要的是，心脏重症监护医生对心肺生理学和心肺转流术后的后果有全面的了解。大多数心脏手术后可预防的死亡都与重症监护病房（ICU）中的术后问题有关。未能认识到并从潜在可逆转的并发症中抢救患者是围手术期发病率和死亡率的原因。接受心脏手术的患者通常会出现多种快速变化的临床问题；他们最初不稳定，临床状况极其不稳定。这些患者的术后护理需要了解一般患者护理的基本概念以及这组患者特有的概念。这些患者从手术室返回后的初始管理至关重要，因为此时临床错误可能会产生深远的影响。初始管理应在患者到达心血管重症监护病房（CVICU）之前开始。心脏重症监护医生审查图表并注意手术类型、适应证、术前血流动力学数据、合并症、药物和过敏情况至关重要。患者到达 CVICU 后，从手术和麻醉团队那里获得全面的交接，开始对患者进行仔细的系统评估。心脏重症监护医生应确定在手术室中进行了哪些程序，并询问可能影响患者术后病程的任何术中事件。然后，他们应该作为初始评估的一部分对患者进行体格检查。在初始评估期间，重症监护医生应避免专注于任何一个问题，并尝试全面了解患者的临床状况。全面了解特定的监测和药物输送线以及引流管的位置至关重要。一旦初始评估完成，可以确定、确定优先级并解决具体问题。
