Post-Operative Care of Congenital Heart Disease Patients

Posted by e-Medical PPT Monday, July 12, 2010
Life-threatening problems may occur in the neonate and infant after cardiac surgery because of the interplay of diminished cardiac output (CO), increased metabolic demand, inflammatory responses to cardiopulmonary bypass, and maladaptive responses to stress. Thus Post-Operative Care of patients with complex congenital heart defects is directed at optimization of oxygen delivery to maintain end-organ function and promote wound healing.Assessment of circulatory function in the postoperative congenital heart patient has depended on indirect assessment of CO using parameters such as blood pressure, pulses, capillary refill, and urine output. Because of the limitations of observer dependent assessment of CO, we rely on objective measures of tissue oxygen levels for the complex postoperative patient.Continuous monitoring of the mixed venous saturation (SvO2) allows for identification of acute changes in systemic oxygen delivery and frequently precedes other indicators of decreased CO.A uniform approach to airway maintenance, vascular access, and drug infusions, all universal concerns during the perioperative period, minimizes the potential for these predictable and necessary interventions to result in morbidity or mortality. Management of the postoperative single ventricle patient targets stabilization of the systemic vascular resistance through the use of vasodilators to improve systemic perfusion and simplify ventilator management. Management of any individual patient should be driven by objective analysis of available data and must include efforts to re-evaluate the treatment plan as well as to identify unanticipated problems.

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