Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.
So, today’s tip is a question we got from a reader, Paul, and Paul says, “My wife of 30 years just had triple bypass surgery and they replaced one valve with a mechanical valve and repaired another valve that was leaky. She has been in ICU for five days now. They seem to be giving her excellent care, but I don’t know the difference as I have not been exposed anything like it. I’m practically a basket case trying to make sense of it all.” That’s a great question, Paul, and I’m sorry to hear that your wife had such big heart surgery because it is big surgery, having triple bypass surgery, having one valve repair and one valve replacement.
Now, I have made other videos about what happens post cardiac surgery in intensive care. And if it’s elective surgery, patients should be in ICU for 24, maybe 48 hours at the most, if all goes as planned, if all goes as per care plan. There’s often care plans in place for patients post cardiac surgery and it’s basically that patients need to tick boxes in terms of their progress and if all the boxes are ticked and they should be leaving intensive care within 24 hours, potentially 48 hours at the most.
So, if patients are coming in for a non-elective surgery, like emergency cases or with more than one thing going wrong with the heart, then I’d say being in ICU for five days is no surprise because triple bypass surgery, valve repair, and valve replacement takes much longer than elective cardiac bypass surgery, for example. So, your wife would’ve been in surgery for a much longer time than for elective surgery probably. Therefore, her lungs would’ve been collapsed for a longer period of time because when patients go for cardiac surgery, most of the time, they are on a bypass machine or also known as an ECMO machine. And therefore, their lungs are being collapsed during that period. And the longer the lungs are collapsed for cardiac surgery, the longer it might take for the lungs to reinflate.
And then one of the challenges after cardiac surgery, especially with a lot of pain that patients are going through, is to prevent the pneumonia. So, if your wife was ventilated for one or two days, then she needs to start doing the breathing exercises. Pain needs to be well-controlled. Other complications that might have come in is she might have bled, after prolonged surgery. The risk is very high that there’s postoperative bleeding.
There’s also a risk of your wife going into an irregular heart rhythm, also known as AF (Atrial Fibrillation). She might even be paced temporarily after the surgery. She might have a temporary pacemaker with a mechanical valve. She will also be started on warfarin to keep the blood from clotting too fast so that there’s no blood clots forming around the mechanical valve. So, there’s a number of issues that your wife is probably dealing with at the moment. She might have more than two or three chest drains in because again, because of the nature of the surgery. The doctors and the nurses also need to look out for cardiac tamponade over the next couple of days. There’s a number of issues that the team needs to look for when it comes to postoperative cardiac surgery care.
And again, triple bypass plus valve repair and valve replacement does not sound like it’s straightforward to me. And again, if there’s bleeding, if there’s cardiac issues such as arrhythmias, if there’s a lot of pain, it’s not a straightforward ICU stay and that’s why she’s probably in ICU for five days. If she’s making progress, you should be very happy, and hopefully she can leave ICU in the next day or so.
Other things that can happen, again, if she’s been on bypass for a long-time during surgery, she might be extubated by now, but she might still have some atelectasis, so she might have some BIPAP. She needs to get mobilized. She needs to start doing some deep breathing exercises and so forth.
Other things that need to be looked for is, electrolytes need to be checked. They need to be in balance, especially after cardiac surgery. The worst thing that can happen is that potassium and magnesium are out of balance, and then again, your wife would be at higher risk to develop an irregular heart rhythm. So, there’s a fair bit of monitoring and management going on in ICU after such big cardiac surgery. I hope that helps, Paul.
That is my quick tip for today.
If you have a loved one in intensive care and you have questions, you should go to intensivecarehotline.com and you should call us on one of the numbers on the top of our website or simply send us an email to [email protected].
Also, have a look at our membership site for families in intensive care at intensivecaresupport.org. There, you have access to me and my team, 24 hours a day, and we answer all questions intensive care related, 24 hours a day, in a membership area or via email.
Also, we do medical record reviews for patients in intensive care in real time. When you have your loved one in intensive care, we can look at medical records in real time or we can look after them once your loved one has left intensive care. But it’s so much better if we can look after the medical records while your loved one is in ICU so we can give you our take on the situation and we can give you our insights and help you to ask questions. We also ask questions on your behalf to the intensive care team.
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Thanks for watching.
This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.