Management approach to hemodynamic instability in early postoperative phase

Abstract

Background: This study aims to investigate the management approach to hemodynamic instability due to several surgical reasons in the early postoperative period. Methods: A total of 222 patients who underwent open heart surgery in our clinic and re-exploration in the intensive care unit (ICU) and operating room between January 2006 and January 2012 were included in the study. The patients were divided into three groups. Group 1 (n=47), which constituted the basis of our study, consisted of the patients re-explored in the ICU with the support of cardiopulmonary bypass (CPB); group 2 (n=65) consisted of patients re-explored without CPB support in the ICU, and group 3 (n=110) consisted of patients re-explored in the operating room in the early postoperative period. The CPB time during the primary surgery, re-exploration time (in hours postoperatively), duration and reason for re-exploration, the primary surgery, the procedure performed in the ICU, the presence of postoperative infection, the length of ICU and hospital stay, the need for blood product replacement, and mortality and morbidity outcomes were compared among the groups. Results: Sixty-four percent of the patients required revision due to massive drainage, 20% due to cardiac arrest, and 16% underwent re-exploration due to malign arrhythmia. Of the patients, 74% had postoperative re-exploration, 12% had support by CPB, 8% had revascularization, and 6% had postoperative complication repair. The mortality rate of the patients who were re-explored in the operating room was significantly lower than the other groups (group 1, 72%; group 2, 45%; group 3, 9%). Conclusion: In the patients in whom open heart resuscitation is obligatory ensuring the operating room conditions quickly and effectively in the ICU is life-saving. Effective and timely support of the CPB is essential for a good postoperative intensive care. This process does not bring an extra burden to the patient, protecting the patient from the time loss and adverse events possibly to be encountered during transport.