A 76-year-old female is admitted to the ICU following elective aortic and mitral valve replacement. Transoesophageal echo assessment at the end of surgery showed an ejection fraction of 20%. Her preoperative creatinine was 340 μmol/L. Total bypass time was 240 minutes. On arrival in ICU the patient has the following indices;
- Temperature 35°C
- Atrial pacing (AAI) 80/min
- Systemic blood pressure 85/55 mmHg
- Pulmonary artery pressure 60/30 mm Hg
- Cardiac index 1.5 litres.min.m-2
- Systemic vascular resistance 1700 dyn.sec.cm--5
- Pulmonary artery wedge pressure 10 mmHg
- Central venous pressure 8 mmHg
- The patient is currently on adrenaline 4μg/min by infusion.
a) List the specific clinical and haemodynamic issues for this patient on admission to ICU.
b) Outline your management of these issues.