Perioperative management in cardiovascular surgery
| Autor: | C. Llanos Jorge, J.L. Pérez Vela, M.J. Lopez Gude, en representación del Gtcicyrcp, J.J. Jiménez Rivera |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Perioperative medicine business.industry Cardiogenic shock Prehabilitation Extracorporeal circulation 030208 emergency & critical care medicine Atrial fibrillation medicine.disease 03 medical and health sciences Patient safety 0302 clinical medicine 030228 respiratory system Intensive care Vasoplegia medicine Intensive care medicine business |
| Zdroj: | Medicina Intensiva (English Edition). 45:175-183 |
| ISSN: | 2173-5727 |
| DOI: | 10.1016/j.medine.2020.10.005 |
| Popis: | Cardio-surgical patient care requires a comprehensive and multidisciplinary approach to develop strategies to improve patient safety and outcomes. In the preoperative period, prophylaxis for frequent postoperative complications, such as de novo atrial fibrillation or bleeding, and prehabilitation based on exercise training, respiratory physiotherapy and nutritional and cognitive therapy, especially in fragile patients, stand out. There have been great advances, during the intraoperative phase, such as minimally invasive surgery, improved myocardial preservation, enhanced systemic perfusion and brain protection during extracorporeal circulation, or implementation of Safe Surgery protocols. Postoperative care should include goal-directed hemodynamic theraphy, a correct approach to coagulation disorders, and a multimodal analgesic protocol to facilitate early extubation and mobilization. Finally, optimal management of postoperative complications is key, including arrhythmias, vasoplegia, bleeding, and myocardial stunning that can lead to low cardiac output syndrome or, in extreme cases, cardiogenic shock. This global approach and the high degree of complexity require highly specialised units where intensive care specialists add value and are key to obtain more effective and efficient clinical results. |
| Databáze: | OpenAIRE |
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