Abstract
Surgical, technological, and pharmacologic advances during the past 25 years have enabled complex cardiac surgery to become more routine; however, one cannot underestimate the multiple potential complications that can still arise in the postoperative setting. The anesthesiologist, physician intensivist, and critical care nurse should be thoroughly familiar with a wide range of issues that can arise in the postoperative course in the intensive care unit after a patient has undergone cardiothoracic surgery.
The widespread use of large long-term clinical databases has led to a greater understanding of the most common complications facing cardiothoracic surgical patients and has allowed the delineation of comorbidities or factors associated with significant and commonly occurring postoperative events. Although an extremely vast myriad of noncardiac-related postoperative complications may occur after a patient has undergone cardiac surgery, this chapter will focus on the most common noncardiac complications after the patient has left the cardiac surgical operative arena and entered into the postoperative phase of care, typically provided in the intensive care unit.
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Reference
Luyt CE, Chastre J, Fagon JY (2004) Value of the clinical pulmonary infection score for the identification and management of ventilator-associated pneumonia. Intensive Care Med 30:844–852
Suggested Reading
Bando K, Sun K, Binford RS, Sharp TG (1997) Determinants of longer duration of endotracheal intubation after adult cardiac operations. Ann Thorac Surg 63:1026–1033
Bartzler DW, Hunt DR (2006) The surgical infection prevention and surgical care improvement projects: national initiatives to improve outcomes for patients having surgery. Clin Infect Dis 43:322–330
Canver CC, Chanda J (2003) Intraoperative and postoperative risk factors for respiratory failure after coronary bypass. Ann Thorac Surg 75:853–857
Chertow GM, Levy EM, Hammermesiter KE, Grover F, Daley J (1998) Independent association between acute renal failure and mortality following cardiac surgery. Am J Med 104:343–348
Chertow GM, Burdick E, Honour M, Bonventure JV, Bates DW (2005) Acute kidney injury, mortality, length of stay and costs in hospitalized patients. J Am Soc Nephrol 16:3365–3370
Dellinger EP (2007) Prophylactic antibiotics: administration and timing before operation are more important than administration after operation. Clin Infect Dis 44:929–930
Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T, Cohen J et al (2008) Surviving sepsis campaign: guidelines for management of severe sepsis and shock. Intensive Care Med 34:17–60
Guller U, Anstrom KJ, Holman WL, Allman RM, Sansom M, Peterson ED (2004) Outcomes of early extubation after bypass surgery in the elderly. Ann Thorac Surg 77:781–788
Heffner JE (1989) Medical indications for tracheotomy. Chest 96:186–190
Heffner JE (2001) The role of tracheotomy in weaning. Chest 120:477S–481S
Karkouti K, Beattie WS, Wijeysundara DN, Rao V, Chan C, Dattilo DM et al (2005) Hemodilution during cardiopulmonary bypass is an independent risk factor for acute renal failure in adult cardiac surgery. J Thorac Cardiovasc Surg 129:391–400
Karkouti K, Wijeysundara DN, Yau TM, Callum JL, Cheng DC, Crowther M et al (2009) Acute kidney injury after cardiac surgery: focus on modifiable risk factors. Circulation 119:495–502
Kollef M, Ahrens T, Shannon W (1999) Clinical predictors and outcomes for patients requiring tracheostomy in the intensive care unit. Crit Care Med 27:1714–1720
Kowdley GC, Maithal S, Ahmed S, Naftel D, Karp R (2005) Non-dialysis-dependent renal dysfunction and cardiac surgery: an assessment of perioperative risk factors. Am Heart J 62:64–70
Lee JH, Graber R, Popple CG, Furey E, Lyons T, Murrell HK et al (1998) Safety and efficacy of early extubation of elderly coronary artery bypass surgery patients. J Cardiothorac Vasc Anesth 12:381–384
Lok CE, Austin PC, Wang H, Tu JV (2004) Impact of renal insufficiency on short- and long-term outcomes after cardiac surgery. Am Heart J 148:430–438
Lutfiyya MN, Henley E, Chang LF, Reyburn SW (2006) Diagnosis and treatment of community-acquired pneumonia. Am Fam Physician 73:442–450
Mair J, Hammerer-Lercher A (2005) Markers for perioperative myocardial ischemia: what both interventional cardiologists and cardiac surgeons need to know. Heart Surg Forum 8:E319–E325
Mangano CM, Diamondstone LS, Ramsay JG, Aggarwal A, Herskowitz A, Mangano DT (1994) Renal dysfunction after myocardial revascularization: risk factors, adverse outcomes and hospital resource utilization. Ann Intern Med 128:194–203
Mathew JP, Fontes ML, Tudor IC, James Ramsay J, Duke P, Mazer CD et al (2004) A multicenter risk index for atrial fibrillation after cardiac surgery. JAMA 291:1720–1729
Mauermann WJ, Nemergut EC (2006) The anesthesiologist’s role in the prevention of surgical site infections. Anesthesiology 105:413–421
Meade MO, Guyatt G, Butler R, Elms B, Hand L, Ingram A et al (2001) Trials comparing early versus late extubation following cardiovascular surgery. Chest 120:445s–453s
Milot J, Perron J, Lacasse Y, Lettourneau L, Cartier PC, Maltais F (2001) Incidence and predictors of ARDS after cardiac surgery. Chest 119:884–888
Mohamed R, Thomas R (1999) Perioperative predictors of extubation failure and the effect on clinical outcome after cardiac surgery. Crit Care Med 27:340–347
Ngaage DL, Martins E, Orkell E, Griffin S, Cale AR, Cowen ME et al (2002) The impact of the duration of mechanical ventilation on the respiratory outcome in smokers undergoing cardiac surgery. Cardiovasc Surg 10:345–350
Noora J, Ricci C, Hastings D, Hill S, Cybulsky I (2005) Determination of troponin I release after CABG surgery. J Cardiac Surg 20:129–135
Parikh CR, Mishra J, Thiessen-Philbrook H, Dursun B, Ma Q, Kelly C et al (2006) Uninary IL-18 is an early predictive biomarker for acute kidney injury after cardiac surgery. Kidney Int 70:199–203
Porzecanski I, Bowton DL (2006) Diagnosis and treatment of ventilator-associated pneumonia. Chest 130:597–604
Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S et al (2006) An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 355:2725–2732
Rajakaruna C, Rogers CA, Angelini GD, Ascione R (2005) Risk factors and economic implications of prolonged ventilation after cardiac surgery. J Thorac Cardiovasc Surg 130:1270–1277
Shenkman Z, Shir Y, Blueuberg B, Gross D (1997) The effects of cardiac surgery on early and late pulmonary functions. Acta Anaesthesiol Scand 41:1193–1199
Thakar CV (2008) Acute kidney injury after cardiac surgery. US Nephrol 3:46–50
Weissman C (2004) Pulmonary complications after cardiac surgery. Semin Cardiothorac Vasc Anesth 8:185–211
Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M et al (2007) Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and the Kawasaki Disease Committee Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 116:1736–1754
Wynne R, Botti M (2004) Postoperative pulmonary dysfunction in adults after cardiac surgery with cardiopulmonary bypass: clinical significance and implications for practice. Am J Crit Care 13:384–393
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Conte, A.H., Foroughi, M. (2014). Noncardiac Complications After Cardiac Surgery. In: Dabbagh, A., Esmailian, F., Aranki, S. (eds) Postoperative Critical Care for Cardiac Surgical Patients. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-40418-4_8
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DOI: https://doi.org/10.1007/978-3-642-40418-4_8
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