ABSTRACT
Hemodynamic monitoring and adequate volume-therapy, as well as the treatment with positive inotropic drugs and vasopressors are the basic principles of the postoperative intensive care treatment of patient after cardiothoracic surgery. The goal of these S3 guidelines is to evaluate the recommendations in regard to evidence based medicine and to define therapy goals for monitoring and therapy. In context with the clinical situation the evaluation of the different hemodynamic parameters allows the development of a therapeutic concept and the definition of goal criteria to evaluate the effect of treatment. Up to now there are only guidelines for subareas of postoperative treatment of cardiothoracic surgical patients, like the use of a pulmonary artery catheter or the transesophageal echocardiography. The German Society for Thoracic and Cardiovascular Surgery (Deutsche Gesellschaft für Thorax-, Herz- und Gefässchirurgie, DGTHG) and the German Society for Anaesthesiology and Intensive Care Medicine (Deutsche Gesellschaft für Anästhesiologie und lntensivmedizin, DGAI) made an approach to ensure and improve the quality of the postoperative intensive care medicine after cardiothoracic surgery by the development of S3 consensus-based treatment guidelines. Goal of this guideline is to assess the available monitoring methods with regard to indication, procedures, predication, limits, contraindications and risks for use. The differentiated therapy of volume-replacement, positive inotropic support and vasoactive drugs, the therapy with vasodilatators, inodilatators and calcium sensitizers and the use of intra-aortic balloon pumps will also be addressed. The guideline has been developed following the recommendations for the development of guidelines by the Association of the Scientific Medical Societies in Germany (AWMF). The presented key messages of the guidelines were approved after two consensus meetings under the moderation of the Association of the Scientific Medical Societies in Germany (AWMF).
Subject(s)
Cardiac Surgical Procedures , Critical Care/standards , Monitoring, Physiologic/standards , Postoperative Care/standards , Practice Guidelines as Topic , Blood Volume , Critical Care/methods , Germany , Hemodynamics , Humans , Monitoring, Physiologic/methods , Postoperative Care/methods , Vasoconstrictor Agents/therapeutic useABSTRACT
Hemodynamic monitoring and adequate volume-therapy, as well as the treatment with positive inotropic drugs and vasopressors, are the basic principles of the postoperative intensive care treatment of patient after cardiothoracic surgery. The goal of these S3 guidelines is to evaluate the recommendations in regard to evidence based medicine and to define therapy goals for monitoring and therapy. In context with the clinical situation the evaluation of the different hemodynamic parameters allows the development of a therapeutic concept and the definition of goal criteria to evaluate the effect of treatment. Up to now there are only guidelines for subareas of postoperative treatment of cardiothoracic surgical patients, like the use of a pulmonary artery catheter or the transesophageal echocardiography. The German Society for Thoracic and Cardiovascular Surgery and the German Society for Anaesthesiology and Intensive Care Medicine made an approach to ensure and improve the quality of the postoperative intensive care medicine after cardiothoracic surgery by the development of S3 consensus-based treatment guidelines. Goal of this guideline is to assess available monitoring methods and their risks as well as the differentiated therapy of volume-replacement, positive inotropic support and vasoactive drugs, the therapy with vasodilators, inodilators and calcium-sensitizers and the use of intra-aortic balloon pumps. The guideline has been developed according to the recommendations for the development of guidelines by the Association of the Scientific Medical Societies in Germany (AWMF). The presented key messages of the guidelines were approved after two consensus meetings under the moderation of the Association of the Scientific Medical Societies in Germany (AWMF).
Subject(s)
Cardiac Surgical Procedures/methods , Cardiovascular Diseases/physiopathology , Cardiovascular Diseases/therapy , Critical Care/methods , Monitoring, Physiologic/methods , Vascular Surgical Procedures/methods , Anesthesiology/standards , Cardiac Surgical Procedures/standards , Cardiovascular Diseases/drug therapy , Cardiovascular Diseases/surgery , Critical Care/standards , Germany , Humans , Monitoring, Intraoperative/methods , Monitoring, Physiologic/standards , Vascular Surgical Procedures/standardsABSTRACT
OBJECTIVE: To estimate ratios of pulmonary-to-systemic blood flows (Qp/Qs) after stage I palliation (Norwood operation) for hypoplastic left heart syndrome and to determine whether early postoperative death can be associated with abnormalities of Qp/Qs ratios. DESIGN: Retrospective. SETTING: University hospital. PARTICIPANTS: Patients who underwent stage I palliation (Norwood operation) for hypoplastic left heart syndrome (n = 76). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The results of the last intraoperative blood gas analysis were compared between patients who survived the day of operation (58 of 76) and the patients who died intraoperatively or within 4 hours after operation (18 of 76). Qp/Qs ratios were calculated using the Fick principle from arterial and venous oxygen saturations at estimated pulmonary venous oxygen saturation of 95%. A lower arterial oxygen saturation (SaO(2), 69.0 +/- 20.5% v 77.3 +/- 8.5%; p < 0.05) and more marked metabolic acidosis (pH, 7.244 +/- 0.115 v 7.298 +/- 0.095; p < 0.05; base excess, -6.8 +/- 4.4 v -3.0 +/- 4.2; p < 0.05) were observed in nonsurvivors. Calculated Qp/Qs ratios ranged between 0.2 and 6.5 in survivors and between 0.6 and 1.9 in nonsurvivors. CONCLUSIONS: Postoperative excessive pulmonary blood flow was not implicated as a cause of death based on blood gas data and Qp/Qs ratios. In nonsurvivors, low cardiac output and hypoxemia were assumed to be major problems.
