Hypothermia

The haemodynamic status of cardiac surgical patients in the initial 2-h recovery period

BACKGROUND

Critical care nurses caring for cardiac patients in the immediate postoperative period continually make decisions about the implications and treatment of their patients' haemodynamic status.

AIM

The aim of this study was to describe the haemodynamic status of patients on admission to critical care and over the 2-h period following cardiac surgery.

METHODS

A quantitative, descriptive design was used. Data were collected using non-participant observation and an observation tool. The sample consisted of 38 patients.

RESULTS

Analysis of data revealed the dynamic nature of the haemodynamic status of postoperative cardiac patients. On admission, 60% of patients (n=23) were haemodynamically unstable. The instability in these patients (n=23) was due to hypotension (34%), bleeding (21%) and hypoxaemia (18%). During the 2-h recovery period, 55% of patients were hypotensive, 16% of patients had low cardiac output syndrome and 16% of patients had low systemic vascular resistance (SVR) syndrome. Twenty-one percent of patients experienced bleeding complications. Shivering was a clinically significant problem in terms of occurrence (23%) and duration (X=45, S.D.=30 min). Twenty-nine percent of patients (n=11) had a profound deterioration in haemodynamic status, necessitating urgent interventions.

CONCLUSION

Haemodynamic parameters indicate that 95% of patients in this study were haemodynamically unstable at some time during the initial 2-h recovery period. These findings inform resourcing decisions by organisations and have implications for nurses' assessment and interventional haemodynamic decision making.

A patient temperature audit within a theatre recovery unit

Hypothermia in the postoperative recovery phase can be a source of potential danger for patients emerging from anaesthesia. In spite of the vast amount of literature dealing with principles of care in the recovery room, information regarding the incidence of hypothermia appear very limited. This article presents a patient temperature audit to assess whether patients were being discharged from a theatre recovery unit hypothermic. In addition, patient temperatures were recorded both pre- and postoperatively, as well as on discharge from recovery, to monitor the incidence of hypothermia throughout the theatre suite. The results show that patients were being discharged with core body temperatures ranging from 34.8 to 38 degrees C with no incidence of hypothermia recorded when the operating room temperature was above 23 degrees C. In general, the coldest theatres were orthopaedic, with this group of patients showing the most incidence of hypothermia. This article aims to demonstrate the use of clinical audit to investigate and evaluate current practice.