Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast Episode 290: Post-op Cardiac Surgery Care with Mike Grant
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Sep 8, 2024 Dr. Mike Grant returns to discuss post-operative care in cardiac surgery. He dives into the shift towards earlier extubation and advanced sedation techniques that boost recovery. The conversation highlights the declining role of pulmonary artery catheters in low-risk patients and critiques traditional monitoring practices. Grant also addresses the debate over fluid management, advocating for cost-effective crystalloid solutions. Lastly, he emphasizes the importance of patient-centered protocols for device management, paving the way for improved recovery outcomes.
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Prefer Crystalloids Over Albumin
- Use crystalloid fluids first-line for resuscitation after cardiac surgery, over albumin.
- Evidence shows no benefit of albumin compared to balanced salt solutions in outcomes.
Fluid Resuscitation Needs Clinical Judgment
- Avoid relying on central venous pressure alone to guide fluid resuscitation post-op.
- Assess fluid responsiveness clinically, watching trends in vital signs, urine output, and response to boluses.
AKI's Impact and Timing in Cardiac Surgery
- AKI after cardiac surgery ranges widely but minor injury still increases mortality risk.
- Most kidney injury begins intraoperatively; ICU care focuses on preventing worsening.