Introduction

Early postoperative management after cardiac surgery takes place in the critical care unit, enabling the provision of advanced respiratory, cardiovascular and renal support. The patient usually remains intubated and ventilated, with close monitoring of haemodynamic variables, cardiac rhythm and chest drain output. The aim is to achieve metabolic stability through the control of cardiovascular and respiratory parameters.

However, this is threatened even before arrival in the critical care area. Transfer of the patient from the operating table to the critical care unit has the potential for displacement or disconnection of tubes, lines, drains and pacing wires. The risk can be minimized by careful handling, portable monitoring and accompaniment by both anaesthetic and surgical staff.

On arrival, the patient is received by the critical care team to whom relevant information is communicated. Baseline routine tests including arterial blood gas analysis are carried out. In some units, a portable plain chest radiograph is also taken on admission.

Assessment of the adult cardiac surgical patient

Evaluation requires review of the case notes, the patient, the observation charts recording haemodynamic and other parameters, laboratory and radiological tests and an electrocardiogram.

The case notes provide the patient's background information including operative and preoperative data. The admission clerking gives details of the diagnosis, demographics, status (routine, urgent, emergent), preoperative ventricular function and comorbidity, particularly respiratory, renal and neurological dysfunction.