Critical Illness Polyneuropathy in Adults After Cardiac Surgery: a Case Study

Abstract

Case Study T.R. is a 60-year-old man with marked risk factors for heart disease, including a history of cardiac disease in his maternal relatives, use of tobacco, hypertension, obesity, and non–insulin-dependent diabetes mellitus. He arrived at a local emergency department with unstable angina and an inferior myocardial infarction. He was then transferred to another local hospital, where he had cardiac catheterization. Three-vessel coronary artery disease was diagnosed, and left ventricular ejection fraction was 0.15 to 0.20. While T.R. was being scheduled for coronary artery bypass graft (CABG) surgery, ventricular tachycardia developed and required placement of an intra-aortic balloon pump to improve perfusion and halt ischemia. T.R. underwent CABG surgery with saphenous vein grafts to the left anterior descending and the posterior descending coronary arteries. A large pericardial effusion and a transmural infarct with necrosis were found. The left ventricle was in danger of rupturing. In addition to the CABG surgery, a patch repair with biological glue and felt was done. Postoperatively, T.R. remained critically ill with multiple complications. On 2 occasions, he had respiratory insufficiency that required prolonged mechanical ventilation and reintubation. Thrombocytopenia associated with anemia developed and required multiple transfusions of blood products. T.R.’s condition remained hemodynamically unstable, and liver dysfunction developed. In addition, he had Staphylococcus epidermidis septicemia due to an infection at the catheter insertion site. Because of the severity of his illness, T.R. was sedated to reduce oxygen consumption and allow him to rest. After 2 weeks, his condition stabilized, and he was weaned off the sedatives. At that point, flaccid tetraparesis was detected.