Advances in cardiac intensive care

Abstract

The reduction in morbidity after cardiac surgery remains challenging. Recent insights have allowed us to recognize the impact of factors beyond the intraoperative period as significant contributors to morbidity. As our field continues to evolve, future studies should focus on emerging technologies and therapies that facilitate the prevention of physiological states that compound congenital morbidities.

Passive peritoneal drainage improves fluid balance after surgery for congenital heart disease

“…Therefore, achieving negative fluid balance quickly and safely postoperatively in these patients is desirable. Traditional methods employed to this end include intraoperative modified ultrafiltration, postoperative fluid restriction, and aggressive diuretic therapy [7]. The vigor with which one is able to implement these modalities to mobilize extravascular fluid, however, is often limited by the need to maintain adequate intravascular volume and end organ perfusion.…”

Is There a Benefit to Postoperative Fluid Restriction Following Infant Surgery?

“…The prevailing consensus is to avoid a hypervolemic state in the immediate postoperative period 10,11 as fluid overload is considered to be a primary risk factor for multiorgan dysfunction. To achieve this goal and accounting for the transient impairment in renal function that follows infant heart surgery, 12 centers institute strategies such as postoperative peritoneal dialysis in addition to restricting fluid intake to 50% of full maintenance.…”

“…To achieve this goal and accounting for the transient impairment in renal function that follows infant heart surgery, 12 centers institute strategies such as postoperative peritoneal dialysis in addition to restricting fluid intake to 50% of full maintenance. 1,10,13 However, this strategy of tight fluid restriction may be not as critical in the current era, as smaller pump prime volumes are being utilized during CPB along with the use of steroids to limit the inflammatory response. 1 In addition, the use of post-CPB modified ultrafiltration has resulted in a reduction of excess total body water accumulation.…”

Nutrition Support After Neonatal Cardiac Surgery

“…Three of these complications-acute renal failure (ARF), chylothorax, and neurological dysfunction-are reviewed. [4][5][6][7] A case study reviewing a feeding methodology used at one institution after neonatal cardiac surgery is provided. The case study delineates obstacles and complications that affect the provision of nutrition support after cardiac surgery in the neonate.…”