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Intensive Care Unit and Stepdown Management

  • Arturo Cardounel
  • Carlos-Eduardo Diaz-Castrillon
  • Edgar Aranda-Michel
  • Christopher M. SciortinoEmail author
Living reference work entry
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Part of the Organ and Tissue Transplantation book series (OTT)

Abstract

Heart transplant is the definitive treatment for patients with end-stage heart failure. Patients who undergo a transplant have the same physiologic burden as typical cardiac procedures with the added strain of organ transplant and immunosuppression. In this chapter, current principles in the postoperative management of the heart transplant patient are discussed. This includes a systematic review of surgical issues presenting in the immediate postoperative period and the physiological perturbations unique to the transplant patient. Standard of care in hemodynamic monitoring and mechanical ventilatory support methods are discussed with a focus on the postoperative transplant patient. Management of hemodynamic instability and common arrhythmias occurring in the perioperative period will be discussed with a review of pharmacological and mechanical approaches used in the management of these problems. Finally, nutritional guidelines pertaining to postcardiotomy patients with specific recommendations related to the transplant patient are reviewed.

Keywords

Heart transplant Cardiac surgery Cardiac critical care Heart failure Intensive care 

References

  1. (1988) Report of the National Cholesterol Education Program Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults. The expert panel. Arch Intern Med 148(1):36–69Google Scholar
  2. Berger MM, Delodder F, Liaudet L, Tozzi P, Schlaepfer J, Chiolero RL, Tappy L (2013) Three short perioperative infusions of n-3 PUFAs reduce systemic inflammation induced by cardiopulmonary bypass surgery: a randomized controlled trial. Am J Clin Nutr 97(2):246–254CrossRefGoogle Scholar
  3. Chermesh I, Hajos J, Mashiach T, Bozhko M, Shani L, Nir RR, Bolotin G (2014) Malnutrition in cardiac surgery: food for thought. Eur J Prev Cardiol 21(4):475–483CrossRefGoogle Scholar
  4. Costanzo MR, Dipchand A, Starling R, Anderson A, Chan M, Desai S, Fedson S, Fisher P, Gonzales-Stawinski G, Martinelli L, McGiffin D, Smith J, Taylor D, Meiser B, Webber S, Baran D, Carboni M, Dengler T, Feldman D, Frigerio M, Kfoury A, Kim D, Kobashigawa J, Shullo M, Stehlik J, Teuteberg J, Uber P, Zuckermann A, Hunt S, Burch M, Bhat G, Canter C, Chinnock R, Crespo-Leiro M, Delgado R, Dobbels F, Grady K, Kao W, Lamour J, Parry G, Patel J, Pini D, Towbin J, Wolfel G, Delgado D, Eisen H, Goldberg L, Hosenpud J, Johnson M, Keogh A, Lewis C, O'Connell J, Rogers J, Ross H, Russell S, Vanhaecke J, International Society of Heat and Lung Transplantation Guidelines (2010) The International Society of Heart and Lung Transplantation Guidelines for the care of heart transplant recipients. J Heart Lung Transplant 29(8):914–956CrossRefGoogle Scholar
  5. Dreymueller D, Goetzenich A, Emontzpohl C, Soppert J, Ludwig A, Stoppe C (2016) The perioperative time course and clinical significance of the chemokine CXCL16 in patients undergoing cardiac surgery. J Cell Mol Med 20(1):104–115CrossRefGoogle Scholar
  6. Drover JW, Cahill NE, Kutsogiannis J, Pagliarello G, Wischmeyer P, Wang M, Day AG, Heyland DK (2010) Nutrition therapy for the critically ill surgical patient: we need to do better! JPEN J Parenter Enteral Nutr 34(6):644–652CrossRefGoogle Scholar
  7. Engelman DT, Adams DH, Byrne JG, Aranki SF, Collins JJ Jr, Couper GS, Allred EN, Cohn LH, Rizzo RJ (1999) Impact of body mass index and albumin on morbidity and mortality after cardiac surgery. J Thorac Cardiovasc Surg 118(5):866–873CrossRefGoogle Scholar
  8. Guida B, Perrino NR, Laccetti R, Trio R, Nastasi A, Pesola D, Maiello C, Marra C, De Santo LS, Cotrufo M (2009) Role of dietary intervention and nutritional follow-up in heart transplant recipients. Clin Transpl 23(1):101–107CrossRefGoogle Scholar
  9. Heyland D, Muscedere J, Wischmeyer PE, Cook D, Jones G, Albert M, Elke G, Berger MM, A. G. Day and G. Canadian Critical Care Trials (2013) A randomized trial of glutamine and antioxidants in critically ill patients. N Engl J Med 368(16):1489–1497CrossRefGoogle Scholar
  10. Heyland DK, Dhaliwal R, Wang M, Day AG (2015) The prevalence of iatrogenic underfeeding in the nutritionally ‘at-risk’ critically ill patient: results of an international, multicenter, prospective study. Clin Nutr 34(4):659–666CrossRefGoogle Scholar
  11. Jakob SM, Stanga Z (2010) Perioperative metabolic changes in patients undergoing cardiac surgery. Nutrition 26(4):349–353CrossRefGoogle Scholar
  12. Kim BS, Jacobs D, Emontzpohl C, Goetzenich A, Soppert J, Jarchow M, Schindler L, Averdunk L, Kraemer S, Marx G, Bernhagen J, Pallua N, Schlemmer HP, Simons D, Stoppe C (2016) Myocardial ischemia induces SDF-1alpha release in cardiac surgery patients. J Cardiovasc Transl Res 9(3):230–238CrossRefGoogle Scholar
  13. Kirklin JK, Young JB, McGiffin DC (2002) Heart Transplantation. Philadelphai: Churchill LivingstoneGoogle Scholar
  14. Kobashigawa J, Zuckermann A, Macdonald P, Leprince P, Esmailian F, Luu M, Mancini D, Patel J, Razi R, Reichenspurner H, Russell S, Segovia J, Smedira N, Stehlik J, Wagner F, Consensus Conference Participants (2014) Report from a consensus conference on primary graft dysfunction after cardiac transplantation. J Heart Lung Transplant 33(4):327–340CrossRefGoogle Scholar
  15. Konstam MA, Kiernan MS, Bernstein D, Bozkurt B, Jacob M, Kapur NK, Kociol RD, Lewis EF, Mehra MR, Pagani FD, Raval AN, Ward C, American Heart Association Council on Clinical Cardiology, Council on Cardiovascular Disease in the Young, Council on Cardiovascular Surgery and Anesthesia (2018) Evaluation and management of right-sided heart failure: a scientific statement from the American Heart Association. Circulation 137(20):e578–e622CrossRefGoogle Scholar
  16. Kouchoukos NT, Blackstone EH (2013) Cardiac transplantation. In: Kouchoukos NT, Blackstone EH, Hanley FL, Kirklin JK (eds) Cardiac surgery. Elsevier, PhiladelphiaGoogle Scholar
  17. Leong JY, van der Merwe J, Pepe S, Bailey M, Perkins A, Lymbury R, Esmore D, Marasco S, Rosenfeldt F (2010) Perioperative metabolic therapy improves redox status and outcomes in cardiac surgery patients: a randomised trial. Heart Lung Circ 19(10):584–591CrossRefGoogle Scholar
  18. Liao KK, Shumway SJ (2014) Cardiac transplantation. In: Yuh DD, Vricella LA, Yang SC, Doty JR (eds) Johns Hopkins textbook of cardiothoracic surgery. McGraw HillGoogle Scholar
  19. Ljungqvist O, Soreide E (2003) Preoperative fasting. Br J Surg 90(4):400–406CrossRefGoogle Scholar
  20. Lomivorotov VV, Efremov SM, Boboshko VA, Nikolaev DA, Vedernikov PE, Deryagin MN, Lomivorotov VN, Karaskov AM (2013) Prognostic value of nutritional screening tools for patients scheduled for cardiac surgery. Interact Cardiovasc Thorac Surg 16(5):612–618CrossRefGoogle Scholar
  21. National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome Clinical Trials Network, Rice TW, Wheeler AP, Thompson BT, Steingrub J, Hite RD, Moss M, Morris A, Dong N, Rock P (2012) Initial trophic vs full enteral feeding in patients with acute lung injury: the EDEN randomized trial. JAMA 307(8):795–803CrossRefGoogle Scholar
  22. Rahman A, Hasan RM, Agarwala R, Martin C, Day AG, Heyland DK (2016) Identifying critically-ill patients who will benefit most from nutritional therapy: further validation of the “modified NUTRIC” nutritional risk assessment tool. Clin Nutr 35(1):158–162CrossRefGoogle Scholar
  23. Sanchez JA, Sanchez LL, Dudrick SJ (2011) Nutritional considerations in adult cardiothoracic surgical patients. Surg Clin North Am 91(4):857–875. ixCrossRefGoogle Scholar
  24. Segovia J, Cosio MD, Barcelo JM, Bueno MG, Pavia PG, Burgos R, Serrano-Fiz S, Garcia-Montero C, Castedo E, Ugarte J, Alonso-Pulpon L (2011) RADIAL: a novel primary graft failure risk score in heart transplantation. J Heart Lung Transplant 30(6):644–651CrossRefGoogle Scholar
  25. Shemin RJ, Deng M (2018) Heart transplantation. In: Cohn L, Adams D (eds) Cardiac surgery in the adult. McGraw Hill, New YorkGoogle Scholar
  26. Stoppe C, Meybohm P, Coburn M, Goetzenich A (2016) [Cardioprotection in cardiac surgical patients: everything good comes from the heart]. Anaesthesist 65(3):169–182Google Scholar
  27. Stoppe C, Goetzenich A, Whitman G, Ohkuma R, Brown T, Hatzakorzian R, Kristof A, Meybohm P, Mechanick J, Evans A, Yeh D, McDonald B, Chourdakis M, Jones P, Barton R, Tripathi R, Elke G, Liakopoulos O, Agarwala R, Lomivorotov V, Nesterova E, Marx G, Benstoem C, Lemieux M, Heyland DK (2017) Role of nutrition support in adult cardiac surgery: a consensus statement from an international multidisciplinary expert group on nutrition in cardiac surgery. Crit Care 21(1):131CrossRefGoogle Scholar
  28. Yazdchi F, Rawn JD (2018) Post-operative care of cardiac surgery patients. In: Cohn L, Adams D (eds) Cardiac surgery in the adult. McGraw Hill, New YorkGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Arturo Cardounel
    • 1
  • Carlos-Eduardo Diaz-Castrillon
    • 2
  • Edgar Aranda-Michel
    • 1
  • Christopher M. Sciortino
    • 1
    Email author
  1. 1.University of Pittsburgh Medical CenterPittsburghUSA
  2. 2.Department of Cardiothoracic SurgeryUniversity of PittsburghPittsburghUSA

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