ICU Management Following Cardiac Surgery

First Things First

  • Get report from surgery/anesthesia team and assess for the following:


  • Security and depth of ETT upon arrival
  • Difficulties with intubation


  • Oximetric saturation and PaO2 for a given amount of FiO2 and PEEP


  • pH and pCO2 for a given tidal volume, respiratory rate and peak inspiratory pressure


  • MAP, SBP and DBP, as supported by
    • CO, SVR, CVP, PAOP/PAD, rhythm
    • Hemodynamically active drug infusions
  • Correlation of filling pressures with ventricular dimensions on 2D TEE
  • Intraoperative segmental wall motion abnormalities
  • Intraoperative TEE assessment of native valves, replaced/repaired valves
  • ASD or VSD?
  • IABP timing and adequacy of both systolic and diastolic augmentation
  • General function of LVAD, RVAD or BIVAD


  • Bladder and core (intravascular) temperature
  • Degree to which patient was cooled and subsequently warmed intraoperatively

Fluids, electrolytes and renal function

  • Intraoperative measures of electrolytes (most notably last values for potassium)
  • Total fluids and blood products
  • Intraoperative urine output

Hematological (oxygen carrying capacity)

  • Estimates of blood loss
  • Salvaged blood returned
  • Total PRBC products administered

Hematological (capacity to clot)

  • ACT
    • Prebypass
    • Post heparin
    • Postbypass
    • Post protamine
  • Amount of heparin administered in total, types and amounts of non-PRBC blood products (platelets, FFP, cryoprecipitate)
  • Hematologically active drugs administered (aminocaproic acid, tranexemic acid, DDAVP)


  • Intraoperative blood glucoses
  • Amount and route of insulin given
  • Infectious disease defenses
  • Timing and dose of perioperative antibiotics


  • Type, timing and doses of:
    • Narcotics, benzodiazepines
    • Neuromuscular blocking agents,
    • Volatile anesthetics, intravenous anesthetics

Surgical specifics

  • Bypass grafts
    • Number
    • Location
    • Types performed (vein, radial, mammary, etc.)
  • Any portion of diseased coronary circulation not amenable to bypass
  • Type and location of valvular replacement/repair
  • Total CPB time, total cross-clamp time

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Last updated: April 22, 2010