Post-Operative Haemodynamic Monitoring of Patients Undergoing Corrective Open Heart Surgery for Structural Heart Defects

Abstract

Abstract Background Accurate hemodynamic monitoring is vital in the diagnosis and management of critically ill patients. The best method for monitoring remains controversial, Adequate perioperative management guided by effective monitoring can help reduce the risk of complications and thus potentially improve outcomes. Aim of Work To compare monitoring methods of cardiac output and systemic haemodynamics post cardiac surgery and its correlation to the clinical status of patients (reflected by clinical signs and laboratory assessment) and outcome, focusing on noninvasive cardiometry and echocardiography. Methodology This is a cross sectional study that was conducted on 40 pediatric patients under 5 years old who were admitted to Post Cardiac Surgery Intensive Care Unit –Academic Institute of Heart Surgery undergoing corrective cardiac surgeries for congenital cardiac lesions. Assessment of hemodynamic changes during immediate post operative period was done by tracing and comparing vital data, echocardiography, non- invasive cardiometry parameters and levels of serum BNP and lactate in all patients at 6 hours and 24 hours post operatively. Results There was statistically significant change in heart rate, urine output, lactate and BNP being high in 1st 6 hours then decreased in 24 hours assessment, versus the observed increase in temperature and SVO2 between the 2-time intervals in immediate post operative period. This was significantly correlated with the decrease in (TAPSE, thoracic fluid content, Cardiac index) and the increase in (LVOT, IVC collapsibility index, fluid total content) parameters by echocardiography and non-invasive cardiometry. Significant correlation was found between clinical evaluation of low cardiac output patients and TAPSE in the 1st 6 hours being decreased in low COP group, while with EF in the 1st 24 hours assessment being decreased in the low COP group. Thoracic fluid content measured by non-invasive cardiometry was significantly related to time on the bypass machine which may affect outcome of patients post operatively. Icon and echocardiography were significantly related on fluid assessment paraments between IVC collapsibility by echo and FTC, TFC by icon, this was also observed in contractility parameters between TAPSE by echo and cardiac index by icon. There was no significant correlation between the end outcome of the studied groups and the 1st 24 hours assessment. Conclusion Clinical evaluation by the attended Physician observing low cardiac output signs and symptoms remains a corner stone in the assessment of haemodynamics in critically ill patients, however fluid assessment tools by both echocardiography and non-invasive cardiometry along with contractility assessment by echocardiography for both right and left ventricle potentially assists physician in his task. There is no upper role for non-invasive cardiometry over echocardiography in monitoring of haemodynamics postoperatively except for assessment of thoracic fluid content which may aid in ventilation and early extubation of patients.