TY - CHAP M1 - Book, Section TI - Postoperative Management of the Cardiac Surgical Patient A1 - Ginwalla, Rashna A1 - Faraday, Nauder A1 - Whitman, Glenn A2 - Yuh, David D. A2 - Vricella, Luca A. A2 - Yang, Stephen C. A2 - Doty, John R. PY - 2014 T2 - Johns Hopkins Textbook of Cardiothoracic Surgery AB - Cardiac surgery involves unique anatomic and physiologic stresses that tax the reserve of every organ system. Continuous postoperative surveillance is required for early recognition of pathology and for rapid institution of organ and life-preserving therapies.Cardiac surgery causes transient (lasting 12–24 h) myocardial injury, sympathetic hyperreactivity, and the systemic inflammatory response syndrome (SIRS) in nearly all patients. As a result, hemodynamic instability requiring transient pressor and/or vasodilator infusions and intravascular volume expansion should be expected in all patents during the first 6 to 24 postoperative hours.Atrial fibrillation/flutter occurs in 30 percent of patients after cardiac surgery, and its incidence can be reduced by half through prophylactic administration of β-blockers, amiodarone, or sotalol.Significant pulmonary compromise should be expected in all cardiac surgical patients postoperatively, with 5 percent of patients experiencing overt respiratory failure. Diuresis should be instituted as soon as SIRS abates to limit fluid accumulation in the injured post-CPB lung.Liberation from mechanical ventilation should be sought at the earliest possible time in all patients. Extubation in most patients can be achieved as soon as they are awake enough to maintain airway patency and achieve adequate spontaneous gas exchange. In patients with significant respiratory compromise, daily assessment of a spontaneous breathing trial is the best method to assess readiness for extubation.Aggressive glucose control with a goal of 100 to 140 mg/dL within 24 h of ICU arrival reduces the incidence of death, sepsis, and renal failure after cardiac surgery. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accesssurgery.mhmedical.com/content.aspx?aid=1104588643 ER -