Spezielle Aspekte der intensivmedizinischen Therapie nach herzchirurgischen Eingriffen

Kernaussagen

• Patienten nach einem kardiochirurgischen Eingriff benötigen besondere Aufmerksamkeit und eine spezielle intensivmedizinische Betreuung.

• Zum Basisüberwachung gehören im Wesentlichen EKG, SO₂, ZVD, invasive Blutdruckmessung, Diurese, Blutgasanalyse und Temperaturmessung. Eine erweiterte Überwachung umfasst die Echokardiografie, transpulmonale Thermodilution, kalibrierte Pulskonturanalyse und/oder den pulmonalarteriellen Katheter.

• Postoperative Rhythmusstörungen sind typisch. Insbesondere das Vorhofflimmern tritt häufig auf und kann durch eine einfache Prophylaxe vermindert werden.

• Die kardiale Dysfunktion wird anhand von Zielparametern diagnostiziert und therapiert. Therapeutische Optionen sind die Volumen- und Katecholamingabe und ggf. der Einsatz kardialer Unterstützungssysteme.

• Postoperativ besteht eine erhöhte Gefahr von Thrombembolien und Blutungen. Daher ist eine individuelle und risikoadaptierte Antikoagulation und Antiaggregation notwendig.

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