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Critical care following cardiac surgery 

Critical care following cardiac surgery
Chapter:
Critical care following cardiac surgery
Author(s):

Lisen Hockings

, Deirdre Murphy

, and Carlos Scheinkestel

DOI:
10.1093/med/9780199653478.003.0026
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date: 18 October 2019

Patients undergoing cardiac surgery are increasingly older and medically more complex, resulting in longer durations of stay in an intensive care unit (ICU). Care of may be streamlined using clinical pathways, guidelines, and checklists. Recent improvements in care include standardizing practice, starting with the handover. A major paradigm shift in the approach to fluid management is to maintain cardiac surgery patients in a euvolaemic state. There are existing algorithms for dealing with unstable patients with haemodynamic instability or hypoxaemia as well as guidelines for dealing with cardiac arrest in patients with recent sternotomy. Mortality post-coronary graft surgery is usually <2%. For those patients who will not survive, the ethical principles of autonomy, beneficence, non-maleficence, justice, and patient consent must inform all discussions and decisions with respect to end-of-life care in the ICU.

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