Critical Matters Critical Care of the Cardiac Surgery Patient
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Jun 12, 2019 Dr. John Greenwood, an expert in emergency medicine and critical care, shares his insights on managing postoperative cardiac surgery patients. He discusses the vital collaboration between intensivists and surgeons, focusing on patient safety during transitions from the OR to the ICU. Key challenges like glycemic control and the management of atrial fibrillation are explored, along with the complexities of handling refractory shock. Greenwood also emphasizes the importance of simplicity in critical care decisions and reflects on how literature shapes personal growth.
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Use Team Handoff for Safety
- Use a standardized, team-based handoff tool to ensure safe transitions from the OR to ICU.
- Collect detailed surgical, anesthetic, and hemodynamic information during this team huddle at the bedside.
Target Blood Pressure Carefully
- Maintain MAP between 65-80 mmHg post-cardiac surgery, adjusting based on specific cardiac conditions.
- Use norepinephrine as first-line vasopressor and titrate based on individualized hemodynamic goals.
Fluids and Coagulation Management
- Start with balanced crystalloids like lactated ringers for fluid resuscitation after bypass.
- Correct coagulopathy early and switch to balanced blood product transfusion if bleeding persists.
