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Hemodynamic Instability in Cardiac Surgical Patients

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Hemodynamic Monitoring Using Echocardiography in the Critically Ill

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Abstract

Echocardiography has a key role in the hemodynamic evaluation of cardiac surgical patients, before, during, and after surgery. Before surgery, it mostly covers indications for cardiac surgery in patients with cardiogenic shock, and in a multidisciplinary approach it is sound practice to involve cardiologists.

During surgery, the anesthesiologist can continuously monitor the patient with transesophageal echocardiography. This allows not only general hemodynamic monitoring, as described in other chapters, but also evaluation of the adequacy of surgical repair. In the postoperative setting, transesophageal echocardiography should be performed when indicated by clinical signs. At this stage, monitoring using TEE is no longer continuous, even though the probe can often be left in place for some time. After patient extubation, transthoracic echocardiography can be attempted, but it is often of limited quality and usually restricted to some views and indices, and it can leave the physician with some uncertainty.

More often than in other settings, cardiac surgical patients in the peri- and early postoperative setting present some specific alterations that require careful examination, such as tamponade and particularly localized compression (often of the right heart), dynamic obstruction of the left ventricular outflow tract, and regional hypokinesia (suggesting occlusion of the bypass graft).

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Authors and Affiliations

  1. Service d’Anesthésie-Réanimation, Hôpital Européen Georges Pompidou, Université Paris Descartes, 20 rue Leblanc, 75908, Paris cedex 15, France

    Bernard P. Cholley

  2. Service d’Anesthésie-Réanimation, Hôpital Foch, 40 rue Worth, BP 36, 92150, Suresnes, France

    Mireille Cherqui

  3. Département de Chirurgie Cardio-Vasculaire, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75908, Paris cedex 15, France

    Alain Berrebi

  4. Department of Anesthesiology and Perioperative Medicine, Flemish University Hospital, Laarbeeklaan 101, 81090, Brussels, Belgium

    Jan Poelaert

Authors
  1. Bernard P. Cholley
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  2. Mireille Cherqui
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  3. Alain Berrebi
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  4. Jan Poelaert
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Corresponding author

Correspondence to Bernard P. Cholley .

Editor information

Editors and Affiliations

  1. , Department of Intenisve Care, Erasme University Hospital, route de Lennik 808, Bruxelles, 1070, Belgium

    Daniel de Backer

  2. Service d'Anesthésie-Réanimation, Hôpital Européen Georges Pompidou, rue Ambroise Paré 2, Paris CX 10, 75475, France

    Bernard P. Cholley

  3. , Unité de Réanimation Médicale, Centre Hospitalier Universitaire, Avenue Laennec, Amiens Cedex 1, 80054, France

    Michel Slama

  4. Ambroise Paré, Intensive Care & Reanimation Unit, Centre Hospitalier Universitaire, avenue Charles de Gaulle 9, Boulogne Cedex, 92104, France

    Antoine Vieillard-Baron

  5. Hôpital Dupuytren, Dépt. Soin Intensive, Université de Limoges, avenue Martin Luther King 2, Limoges, 87042, France

    Philippe Vignon

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Cholley, B.P., Cherqui, M., Berrebi, A., Poelaert, J. (2011). Hemodynamic Instability in Cardiac Surgical Patients. In: de Backer, D., Cholley, B., Slama, M., Vieillard-Baron, A., Vignon, P. (eds) Hemodynamic Monitoring Using Echocardiography in the Critically Ill. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-87956-5_19

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  • DOI: https://doi.org/10.1007/978-3-540-87956-5_19

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-87954-1

  • Online ISBN: 978-3-540-87956-5

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