From the Guidelines
Usual care post cardiac surgery should include arrhythmia monitoring for a minimum of 48 to 72 hours postoperatively for patients with uncomplicated open heart surgery, as recommended by the American Heart Association 1. This approach is based on the latest guidelines, which emphasize the importance of monitoring for arrhythmias, such as atrial fibrillation, in the postoperative period. The recommendations are classified as Class I, Level of Evidence B, indicating a strong recommendation based on moderate-quality evidence. Key aspects of usual care post cardiac surgery include:
- Arrhythmia monitoring for at least 48 to 72 hours after uncomplicated open heart surgery 1
- Extended monitoring for patients at high risk for atrial fibrillation, for the duration of their hospitalization in an acute care unit 1
- Ischemia monitoring intraoperatively and in the immediate postoperative setting for high-risk patients or those who may have difficulty recognizing and reporting new or ongoing ischemia 1 These measures aim to prevent and detect potential complications, such as arrhythmias and ischemia, and to promote optimal recovery and outcomes for patients after cardiac surgery.
From the Research
Usual Care Post Cardiac Surgery
- The usual care post cardiac surgery involves a comprehensive understanding of cardiopulmonary physiology and the sequelae of cardiopulmonary bypass 2.
- It is essential to have a structured approach to management, including adequate fluid resuscitation, appropriate inotropic support, attention to rewarming, and ventilator management 3.
- The cardiac intensivist should review the chart, note the type of surgery, indications, preoperative hemodynamic data, comorbid conditions, medications, and allergies before the patient arrives in the cardiovascular intensive care unit (CVICU) 2.
- A careful systematic assessment of the patient should begin with obtaining a comprehensive handoff from the surgical and anesthesia team, followed by a physical examination of the patient 2.
- The initial management should focus on getting a global picture of the patient's clinical status, rather than focusing on any one issue 2.
Management of Complications
- Postoperative complications after cardiac surgery can involve the cardiovascular and respiratory system, as well as the kidneys and central nervous system 4.
- The most recent evidence suggests that fluid and inotropes administration should be targeted to maintain a cardiac index above 3 l/min/m throughout the perioperative period 4.
- Volatile anaesthesia and mechanical ventilation with low tidal volumes, low driving pressure, and moderate-low positive end-expiratory pressure should be preferred 4.
- Preoperative steroids could reduce postoperative atrial fibrillation, whereas no drug has shown to effectively prevent kidney injury 4.
Pain Management
- Postoperative pain-management with non-steroid anti-inflammatory drugs, such as ibuprofen, has been controversial due to related side-effects 5.
- A randomized controlled trial found that slow-release ibuprofen combined with lansoprazole was not associated with a greater risk of harm compared to an oxycodone-based regimen, but renal function should be closely monitored 5.