Hemodynamics in the Cardiothoracic Intensive Care Unit: The Nursing Prospective

  • Mary Ellen Kern

Abstract

In the last twenty years, the delivery of healthcare at the bedside in the cardiothoracic intensive care unit (ICU) has become more complicated not only in terms of technology but also because of increased patient acuity, socioeconomic changes and constraints. The ’80s and ’90s have been marked by an increase in physiologic information and a multitude of options offered to the cardiothoracic surgical patient. This has certainly contributed to the complexity of issues now seen in the surgical suite and subsequently postoperatively in the cardiothoracic ICU. The cardiothoracic nurse is faced with an increased challenge in care which may vary according to the labor experience and educational background. Aside from achieving a level of comfort with the basic technical tasks of postoperative cardiothoracic care, the nurse is also challenged by the pharmacologic management and its integration with the hemodynamic status of the patient. The use of a wide variety of available vasoactive and hemodynamically responsive agents demands constant vigilance, reading and education on the part of those professionals who assume this awesome challenge in care. The integration of cardiopulmonary parameters and drug therapy offers the nurse an opportunity to optimize the patient’s physiology on a moment-to-moment basis.

Keywords

Dopamine Norepinephrine Epinephrine Propranolol Digoxin 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    White K: Using continuous SvO2 to assess oxygen supply/demand balance in the critically ill patient. AACN Clinical Issues in Critical Care Nursing 1993; 4(1): 134–147.PubMedCrossRefGoogle Scholar
  2. 2.
    Headley J, Diethorn M: Right ventricular volumetric monitoring. AACN Clinical Issues in Critical Care, 1993; 4(1): 120–133.CrossRefGoogle Scholar
  3. 3.
    Ahrens T: Integration of hemodynamics and oxygenation. Trends in Critical Care, presentation, Philadelphia, PA, 1993.Google Scholar
  4. 4.
    Brandfonbrener M, Landowne M, Shock NW: Changes in cardiac output with age. Circulation, 1957; 12: 557.CrossRefGoogle Scholar
  5. 5.
    Grossman W, Bain DS: Cardiac Catheterization Angiography and Intervention, 4th ed., Lea & Febinger, Philadelphia, PA, 1991.Google Scholar
  6. 6.
    Smolensky MH, Tatar SE, Bergman SA, et al: Orcadian rhythmic aspect of human cardiovascular function: a review of chronobiologic statistical methods. Chronobiologia 1976; 3: 337–371.PubMedGoogle Scholar
  7. 7.
    Urban N: Hemodynamic clinical profiles. AACN Clinical Issues in Critical Care Nursing 1990; 1: 123.Google Scholar
  8. 8.
    Clark B: Beta adrenergic blocking agents: their current status. AACN Clinical Issues in Critical Care Nursing, 1992; 3(2): 447–460.PubMedGoogle Scholar
  9. 9.
    Blanski L, Lutz J, Laddu A: Esmolol, the first ultra-short-acting intravenous beta blocker for use in critically ill patients. Heart & Lung, 1988; 17(1): 80–89.Google Scholar
  10. 10.
    Larsen LS, Larsen A: Labetalol in the treatment of epinephrine overdose. Ann Emerg Med 1990; 19: 680–682.PubMedCrossRefGoogle Scholar
  11. 11.
    White P: Calcium channel blockers. AACN Clinical Issues In Critical Care Nursing 1992; 3(2): 437–446.PubMedGoogle Scholar
  12. 12.
    D’Ambra MN, La Raia PJ, Philbin DM et al: Prostaglandin E1. A new therapy for refractory right heart failure and pulmonary hypertension after mitral valve replacement. J Thorac Cardiovasc Surg 1985; 89: 567–572.PubMedGoogle Scholar
  13. 13.
    LeDoux, D: Management of heart failure in cardiac surgical patients: amrinone and other pharmacologic agents. Progress in Cardiovascular Nursing, 1990; 5(3): 78–83.Google Scholar
  14. 14.
    Goenen M, Pedemonte O, Baele P, Col J: Amrinone in the management of low cardiac output after open heart surgery. Am J Card 1985; 56: 33B–38B.PubMedCrossRefGoogle Scholar
  15. 15.
    Gunnicker M, Hess W: Preliminary results with amrinone in perioperative low cardiac output syndrome. Thorac Cardiovasc Surg 1987; 35: 219–225.PubMedCrossRefGoogle Scholar
  16. 16.
    Feneck RO: Effects of variable dose milrinone in patients with low cardiac output after cardiac surgery. Am Heart J 1991; 121: 1995–1999.PubMedCrossRefGoogle Scholar
  17. 17.
    Wright EM, Sherry KM: Clinical and haemodynamic effects of milrinone in the treatment of low cardiac output after cardiac surgery. Br J Anaes 1991; 67: 585–590.CrossRefGoogle Scholar
  18. 18.
    Bairn DS, McDowell AV, Cherniles J, et al: Evaluation of a new bipyridine inotropic agent — milrinone in patients with severe congestive heart failure. N Engl J Med 1983; 309: 748–756.CrossRefGoogle Scholar
  19. 19.
    Monrad ES, McKay RG, Bairn DS, et al: Improvement in indexes of diastolic performance in patients with congestive heart failure treated with milrinone. Circulation 1984; 70: 1030–1037.PubMedCrossRefGoogle Scholar
  20. 20.
    Smith GW, O’Connor SE: An introduction to the pharmacologic properties of Dopacard (dopexamine). Am J Cardiol 1988; 62: 9C–17C.PubMedCrossRefGoogle Scholar
  21. 21.
    Gollub SB, Emmot WW, Johnson DE et al: Hemodynamic effects of dopexamine hydrochloride infusions of 48–72 hours duration for severe congestive heart failure. Am J Cardiology, 1988; 62: 83C–88C.CrossRefGoogle Scholar
  22. 22.
    Watson: The isolation of dopamine. J Am Pharm Assoc 1944; 33: 270.Google Scholar
  23. 23.
    Miller CD, Stinson EB, Oyer PE, Derby GC, Reitz BA, Shumway NE: Postoperative enhancement of left ventricular performance by combined inotropic-vasodilator therapy with preload control. Thorac Cardiovasc Surg 1980; 88: 108.Google Scholar
  24. 24.
    Haft JI, Kranz PD, Albert FJ, et al: Intravascular platelet aggregation in the heart induced by norepinephrine: microscopic studies. Circulation 1972; 46: 698–707.PubMedCrossRefGoogle Scholar
  25. 25.
    Takamine: Isolation of epinephrine from animal tissue. J Soc Chem Ind 1901; 20: 746.Google Scholar
  26. 26.
    Aldrich: Isolation of epinephrine. Am J Physiology 1901; 5: 547.Google Scholar
  27. 27.
    Roberts JR, Krisanda TJ: Accidental intra-arterial injection of epinephrine treated with phentolamine (letter) Ann Internal Med 1989; 18: 424–425.Google Scholar
  28. 28.
    Bergman and Sulzbacher: Synthesis of phenylephrine. J Organic Chemistry 1951; 16: 84.CrossRefGoogle Scholar
  29. 29.
    Bourdarias JP, Dubourg O, Gueret P, et al: Inotropic agents in the treatment of cardiogenic shock. Pharmac Ther 1983; 22: 53–79.CrossRefGoogle Scholar
  30. 30.
    Tright PV, Spray T, Pasque M, et al: The comparative effects of dopamine and dobutamine on ventricular mechanics after coronary artery bypass grafting: a pressure dimension analysis. Circulation 1984; 70: I-112-117.Google Scholar
  31. 31.
    Corr L, Grounds RM, Brown MJ, et al: Plasma catecholamine changes during cardiopulmonary bypass: a randomized double blind comparison of trimethaphan camsylate and sodium nitroprusside. Br Heart J 1986; 56: 89–93.PubMedCrossRefGoogle Scholar

Further Suggested Bibliography

  1. Clements J: Sympathomimetics, inotropics and vasodilators. AACN Clinical Issues in Critical Care Nursing, 1992 (2): 395–408.Google Scholar
  2. Deglin J, Deglin S: Hypertension: current trends and choice in pharmacotherapeutics. AACN Clinical Issues in Critical Care Nursing, 1992; 3(2): 507–526.PubMedGoogle Scholar
  3. Kelleher R, Rose A, Ordway L: Prostaglandins for the control of pulmonary hypertension in the postoperative cardiac surgery patient: nursing implications. Critical Care Nursing Clinics of North America, 1991; 3(4): 741–748.PubMedGoogle Scholar
  4. Kuhn M: Nitrates. AACN Clinical Issues in Critical Care Nursing, 1992; 3(2): 409–422.PubMedGoogle Scholar
  5. Woods S, Osguthorpe S: Cardiac output determinations. AACN Clinical Issues in Critical Care Nursing 1993; 4(1): 81–97.PubMedCrossRefGoogle Scholar
  6. Zaloga G, Prielipp R, Butterworth J, Royster R: Pharmacologic cardiovascular support. Critical Care Clinics 1993; 9(2): 335–362.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1995

Authors and Affiliations

  • Mary Ellen Kern
    • 1
  1. 1.Robert Wood Johnson Medical School Cooper Hospital/University Medical CenterUniversity of Medicine and Dentistry of New JerseyCamdenUSA

Personalised recommendations