Rincón SJJ, Novoa LE, Sánchez E, Hortal IJ

Idioma: Español
Referencias bibliográficas: 28
Paginas: 172-178
Archivo PDF: 190.85 Kb.

RESUMEN

La atención en cuidados intensivos del paciente sometido a cirugía cardiaca amerita una revisión especial, ya que la mayor complejidad y agresividad de la intervención quirúrgica y del soporte circulatorio, en especial de la circulación extracorpórea, inciden en la evolución y en las complicaciones del paciente; por lo que éste requerirá de una completa monitorización y de un manejo dinámico, integral y multidisciplinario en cuidados intensivos cuando se presente alguna complicación, la cual regularmente va a incidir en la morbimortalidad del paciente. Motivo por lo cual se realiza en este artículo una revisión práctica de las principales complicaciones del postoperatorio inmediato del paciente sometido a cirugía cardiaca con circulación extracorpórea: sangrado mediastínico, disfunción pulmonar aguda, síndrome de bajo gasto cardiaco, arritmias, falla renal aguda y, por otra parte, su abordaje terapéutico.

REFERENCIAS (EN ESTE ARTÍCULO)

1. Bojar RM. Manual of perioperative care in adult cardiac surgery. Fourth edition. Ed. Blackwell Publishing Ltd; 2011.

2. Mariscalco G, et al. Acute kidney injury: a relevant complication after cardiac surgery. Ann Thorac Surg. 2011;92(4):1539-1747.

3. Engoren MC, et al. Effect of blood transfusion on long-term survival after cardiac operation. Ann Thorac Surg. 2002;74(4):1180-1186.

4. Czer LS. Mediastinal bleeding after cardiac surgery: etiologies, diagnostic considerations, and blood conservation methods. J Cardiothorac Anesth. 1989;3(6):760-775.

5. Gravlee GP, Stammers AH, Ungerleider RM. Cardiopulmonary bypass. Principles and Practice. Third edition.Philadelphia: Ed. Lippincott Williams & Wilkins; 2008:

6. Unsworth-White MJ, et al. Resternotomy for bleeding after cardiac operation: a marker for increased morbidity and mortality. Ann Thorac Surg. 1995;59(3):664-667.

7. Meade MO, et al. Trials comparing early versus late extubation following cardiovascular surgery. Chest. 2001;120(6 Suppl):445S-453S.

8. Ng CS, et al. Pulmonary dysfunction after cardiac surgery. Chest. 2002; 121(4): 1269-1277.

9. Shapira N, et al. Determinants of pulmonary function in patients undergoing coronary bypass operations. Ann Thorac Surg. 1990;50(2):268-273.

10. Blanco. Manejo respiratorio en el postoperatorio de cirugía cardiovascular. Cuidados postoperatorios en cirugía cardiovascular. Primera edición. Ed. Panamericana.

11. Eagle KA, et al. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). Circulation. 2004;110(14):e340-e347.

12. Griffin MJ, Hines RL. Management of perioperative ventricular dysfunction. J Cardiothorac Vasc Anesth. 2001;15(1):90-106.

13. Breisblatt WM, et al. Acute myocardial dysfunction and recovery: a common occurrence after coronary bypass surgery. J Am Coll Cardiol, 1990;15(6):1261-9.

14. Van Trigt P, et al. The comparative effects of dopamine and dobutamine on ventricular mechanics after coronary artery bypass grafting: a pressure-dimension analysis. Circulation. 1984;70(3 Pt 2):I112-117.

15. Levy JH, Bailey JM, Deeb GM. Intravenous milrinone in cardiac surgery. Ann Thorac Surg. 2002;73(1):325-330.

16. Toller WG, Stranz C. Levosimendan, a new inotropic and vasodilator agent. Anesthesiology. 2006;104(3):556-569.

17. Esson ML, Schrier RW. Diagnosis and treatment of acute tubular necrosis. Ann Intern Med. 2002;137(9):744-752.

18. Weisberg AD, et al. Preoperative evaluation and preparation of the patient for cardiac surgery. Anesthesiol Clin. 2009;27(4):633-648.

19. Cooper WA, et al. Impact of renal dysfunction on outcomes of coronary artery bypass surgery: results from the Society of Thoracic Surgeons National Adult Cardiac Database. Circulation. 2006;113(8):1063-1070.

20. Wang F, et al. An analysis of the association between preoperative renal dysfunction and outcome in cardiac surgery: estimated creatinine clearance or plasma creatinine level as measures of renal function. Chest. 2003;124(5):1852-1862.

21. Mangano CM, et al. Renal dysfunction after myocardial revascularization: risk factors, adverse outcomes, and hospital resource utilization. The Multicenter Study of Perioperative Ischemia Research Group. Ann Intern Med. 1998;128(3):194-203.

22. Mehta RL, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11(2):R31.

23. Ricci Z, Cruz D, Ronco C. The RIFLE criteria and mortality in acute kidney injury: a systematic review. Kidney Int. 2008;73(5):538-546.

24. Thakar CV, et al. Influence of renal dysfunction on mortality after cardiac surgery: modifying effect of preoperative renal function. Kidney Int. 2005;67(3):1112-1119.

25. Ryckwaert F, et al. Incidence, risk factors, and prognosis of a moderate increase in plasma creatinine early after cardiac surgery. Crit Care Med. 2002;30(7):1495-1498.

26. Ranucci M, et al. Influence of the timing of cardiac catheterization and the amount of contrast media on acute renal failure after cardiac surgery. Am J Cardiol. 2008;101(8):1112-8.

27. Karvellas CJ, et al. A comparison of early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury: a systematic review and meta-analysis. Crit Care. 2011;15(1):R72.

28. Elahi M, et al. Acute kidney injury following cardiac surgery: impact of early versus late haemofiltration on morbidity and mortality. Eur J Cardiothorac Surg. 2009;35(5):854-63.