Hemodynamic considerations in the postoperative management of the cardiovascular surgical patient

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In this communication we shall highlight certain aspects of the postoperative management of the cardiovascular surgical patient as developed and practiced at the University of Alabama in Birmingham. The considerations that we shall emphasize have been inspired and led by Dr. John Kirklin and Drs. Nicholas Kouchoukos, Robert Karp, Albert Pacifico, and members of the cardiovascular surgical team at this medical center.

In our postoperative cardiac intensive care unit, we routinely measure certain parameters to assess the function of the cardiovascular system in the early postoperative period. Arterial pressure is obtained with an indwelling cannula usually placed percutaneously in the radial artery. Heart rate and rhythm are determined from standard electrocardiographic leads. Left and right arterial pressures are determined from fine polyvinyl catheters placed at the time of operation. Measurements of arterial and atrial pressures are obtained at 5- to 15-minute intervals in the first 24 to 48 hours following operation. In our experience, the use of these indwelling arterial and cardiac catheters for this period of time has been associated with an extremely low complication rate. The volume of drainage from pericardial, mediastinal and pleural tubes, the amount of blood infused, and the output of urine from a urethral catheter are recorded at hourly intervals. All the above measurements can be obtained, analyzed, and displayed automatically with a digital computer (Fig. 1). Use of such an automated system has greatly facilitated the management of patients following cardiac surgical procedures.

Cardiac output is usually determined by the indicator dilution technique . . .