ICU · cardiovascular

Post-Cardiac Surgery ICU Management — Comprehensive

Also known as Post-cardiac surgery ICU · Post-CABG ICU · Post-valve surgery ICU · Post-cardiopulmonary bypass · Post-CPB management · Cardiac surgical ICU · Post-sternotomy care · Vasoplegic syndrome post-CPB · Low cardiac output syndrome

Post-cardiac surgery ICU management — the systematic care of patients after cardiopulmonary bypass (CPB) surgery (CABG, valve replacement/repair, aortic surgery). The early postoperative period focuses on: (1) haemodynamic stabilisation (vasoplegic syndrome in 9-44% of bypass patients — NO-mediated distributive shock with a normal or high cardiac index — noradrenaline first, vasopressin, methylene blue 2 mg/kg for refractory; low cardiac output syndrome — dobutamine first-line), (2) bleeding and tamponade assessment (severe chest tube output over 300 mL in the first hour, over 200 in the second and over 100 in the third carries attributable harm; sudden cessation with haemodynamic collapse = clotted tube and tamponade until proven otherwise → URGENT RE-EXPLORATION, which runs at 2.5-3.7% and is safest within 4 hours), (3) rhythm management (new AF in 20-40% with onset on days 2-4 — rate control usually suffices, beta-blocker prophylaxis best established), (4) ventilatory support and weaning (fast-track: extubation within 6 hours in selected patients once warm, stable, not bleeding and awake), (5) temperature and metabolic management (rewarm — hypothermia on ICU arrival predicts bleeding and re-exploration; keep potassium and magnesium replete; tight glucose control improves diabetic CABG outcomes).

Checked against its sources on 2 Sept 2026