This is a condensed revision of Ray Raper's chapter on post-op management of cardiothoracic surgical patients in the ICU. It has been expanded upon by details from the 2004 update to the 1999 AHA guidelines relating to the management of patients recovering from coronary artery bypass graft surgery. The routine care of such patients is never asked about in the written papers, mainly because the college is usually asking about the management of complications, which should not form a part of routine post-operative care.
The perioperative mortality for these people is on average about 3%.
The post-operative course, and the anticipated problems, can be summarised as follows:
In this fashion, 4 hours pass.
There are a few conditions they must meet.
The majority of uncomplicated CABG patients tend to meet these criteria after 4 hours or so.
And those that don't? Why aren't they ready for extubation yet?
The temperature of the patient, and their level of alertness, is something well within your control. Warm them, wake them up, take away the sedating infusions - all of these things will help.
However, the hemodynamic stability and the ventilation are slightly more tricky.
Fremes, S. E., et al. "Effects of postoperative hypertension and its treatment." The Journal of thoracic and cardiovascular surgery 86.1 (1983): 47.
André, Arthur C. St, and Anthony DelRossi. "Hemodynamic management of patients in the first 24 hours after cardiac surgery." Critical care medicine 33.9 (2005): 2082-2093.
Eagle, Kim A., et al. "ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery)." Circulation 110.14 (2004): e340.
Simonet, E., V. Velebit, and M. Schmuziger. "Open chest and delayed sternal closure after cardiac surgery." Eur J Cardio-thorac Surg 10 (1996): 305-311.