Issue |
J Extra Corpor Technol
Volume 46, Number 2, June 2014
|
|
---|---|---|
Page(s) | 142 - 149 | |
DOI | https://doi.org/10.1051/ject/201446142 | |
Published online | 15 June 2014 |
Review Articles
Gastrointestinal Complications and Cardiac Surgery
Address correspondence to: Sara J. Allen, BHB, MBChB, FANZCA, FCICM, Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Private Bag 92024, Auckland Mail Centre, Auckland NZ 1142. E-mail: saraa@adhb.govt.nz
Received:
6
November
2013
Accepted:
2
April
2014
Gastrointestinal (GI) complications are an uncommon but potentially devastating complication of cardiac surgery. The reported incidence varies between .3% and 5.5% with an associated mortality of .3–87%. A wide range of GI complications are reported with bleeding, mesenteric ischemia, pancreatitis, cholecystitis, and ileus the most common. Ischemia is thought to be the main cause of GI complications with hypoperfusion during cardiac surgery as well as systemic inflammation, hypothermia, drug therapy, and mechanical factors contributing. Several nonischemic mechanisms may contribute to GI complications, including bacterial translocation, adverse drug reactions, and iatrogenic organ injury. Risk factors for GI complications are advanced age (>70 years), reoperation or emergency surgery, comorbidities (renal disease, respiratory disease, peripheral vascular disease, diabetes mellitus, cardiac failure), perioperative use of an intra-aortic balloon pump or inotrope therapy, prolonged surgery or cardiopulmonary bypass, and postoperative complications. Multiple strategies to reduce the incidence of GI complications exist, including risk stratification scores, targeted inotrope and fluid therapy, drug therapies, and modification of cardiopulmonary bypass. Currently, no single therapy has consistently proven efficacy in reducing GI complications. Timely diagnosis and treatment, while tailored to the specific complication and patient, is essential for optimal management and outcomes in this challenging patient population.
Key words: abdominal organs / CPB / complications / outcomes / pathophysiology / perioperative care
© 2014 AMSECT
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