Postoperative care of the adult cardiac surgical patient

Most patients are ready to be transferred to a ward after 24–48 hours on a cardiac intensive care unit (CICU); however, several potential complications can occur during this period. The risks during transfer from theatre to CICU increase if a long distance is involved. A thorough handover to nursing staff is mandatory. Problems with blood pressure and arrhythmias are common on the CICU. Drugs or pacing can be used to manipulate heart rate. Patients undergoing hypothermic cardiopulmonary bypass are at greater risk of hypothermia postoperatively. Active and passive warming methods are imperative to avoid complications of hypothermia. Multiple factors can cause postoperative cardiac surgical bleeding. Despite efforts to correct clotting abnormalities, patients occasionally need to return to theatre because of mediastinal bleeding or cardiac tamponade. The avoidance of multiorgan failure by maintaining good tissue perfusion and oxygenation is the main aim of perioperative care. Avoidance or treatment of a low cardiac output state often necessitates cardiac output monitoring and the use of inotropes, vasoactive drugs or mechanical assist devices such as an intra-aortic balloon pump. Established organ failure leads to a longer stay on a CICU; respiratory, renal, neurological and gastrointestinal complications account for a very few patients having a protracted critical care stay.