Postoperative Care in Cardiac Surgery: A Frequent Determinant of Success or Failure

Our experience for the last two years has emphasized the importance of specialized care in patients who have had cardiac surgery, particularly open heart surgery. In addition to adequate surgical repair, the survival of the acutely ill patient with cardiac disease depends upon reducing the number and severity of complications to a minimum. Immediately after cardiac surgery, almost all patients demonstrate some degree of respiratory insufficiency which depresses myocardial function and causes arrhythmias. This, in a patient with an already poor cardiac reserve, may prove fatal. Upon arrival to the recovery room, our patients are placed on the volume-controlled Engstrom respirator while still under light anesthesia or sedatives. Respiration is thus assisted until an adequate level of arterial oxygen tension can be maintained, the electrocardiogram is stable, cardiac output is acceptable, acid-base balance has been corrected, and blood volume and peripheral vascular tone have returned to normal. The safety of this approach depends upon careful monitoring of blood pressures, blood gases, pH, blood volume and cardiac output. Since the institution of specialized supportive care, the dramatic reduction of postoperative complications has convinced us of the rationale of such management.