Intensive care medicine

After the majority of cardiac surgical procedures, a period of intensive monitoring, assessment and therapy is necessary. These patients are transferred to our Intensive Care Units 1 or 2 right after the operation.

Patients often remain under anesthesia during transport from the operating room to the intensive care unit, so most will not remember the first few hours in the ICU. After a period of observation, anesthetic drug infusions are stopped and you will emerge from anesthesia with the intention of removing the breathing tube as soon as possible. The continuous administration of medication, which may have been necessary during the operation to stabilize heart function and blood pressure, can often also be discontinued over the next few hours. As soon as the evening of the operation, you may be able to drink again or even have a light meal. Untreated, every surgical procedure would be associated with pain. During your operation, pain will be controlled by the narcotics provided under general anesthesia. Following surgery, you will continue to receive pain medication in the intensive care unit, to promote an almost painless awakening. We then continue to work closely with you to determine the exact dose of pain medication you will need to optimize to your recovery.

After uncomplicated routine procedures, our aim is for you to sit on the edge of the bed with the help of physiotherapists on the morning after the operation. You may eat your own breakfast and you might be transferred to the ward for further treatment on the first day after the operation .

Occasionally, so-called “weaning” from artificial ventilation might take a few days. This is especially the case with pre-existing lung disease or cardiac insufficiency. In these cases, we will provide you with medication that will enable you to tolerate the breathing tube in the windpipe. Even under these circumstances, it is our goal that you are awake e.g. to prevent weakening of the muscles through physiotherapy.

Other reasons for a prolonged stay in the Intensive Care Unit might be the continued administration of drugs to support your circulation, or other organ dysfunction, such as acute kidney failure.

After certain operations such as transplants, the insertion of a cardiac support system (LVAD / RVAD) or emergency operations, a longer stay in the intensive care unit can also be expected. On each of these treatment days, a highly specialized and motivated team of experienced nurses, physiotherapists and respiratory therapists as well as medical staff will work with you to ensure that you reach your personal goals in terms of health and independence as quickly as possible.

Acute impairment of normal brain function can occasionally occur, especially after cardiac surgery. This clinical picture, called delirium, is characterised by acute states of confusion and behaviour that is inappropriate and possibly puts you at risk, as well as occasionally abrupt changes in the state of wakefulness.

Various measures have been introduced at the DHZB to reduce the likelihood that you will suffer from delirium. This includes avoiding unnecessarily deep levels of anaesthesia by measuring brain waves (EEG), where possible avoiding prolonged sedation (“artificial coma”) in the intensive care unit and proactive standardised reorientation after the operation. If you are dependent on glasses and hearing aids, we will make sure you can use them as soon as you wake up. Your relatives can also contribute to your recovery and reorientation through visits to the intensive care unit: They can explain to you where you are, what has happened and what is being done to help you recover or what is happening at home and with other loved ones. If prolonged treatment is necessary, it often helps if you have a picture that is important to you in sight or if you have brought books and current magazines with you.

Various medical devices are necessary in an intensive care unit in order to monitor organ functions and, if necessary, to provide organ support. These can be intimidating for patients and / or relatives, so we would like to introduce you to the most important ones below:

Monitors are usually installed both next to and above the patient's bed. The cardiac current curve (ECG), blood pressure, the oxygen content of the red blood cells (oxygen saturation) as well as the body temperature are constantly displayed on them. If necessary, other measured values ​​can also be displayed.

Arterial catheters are often placed to enable an accurate measurement of blood pressure. These are thin tubes that are placed in an artery on the wrist or in the groin.

Syringe pumps continuously deliver medication into the bloodstream. For example, this can be medicines to support the cardiovascular system (catecholamines), to fight infections (antibiotics) or pain medication. Central venous catheters (CVC) are often required for this. These are thin tubes that are placed around the neck or under the collarbone and lead into a large blood vessel.

As long as you cannot breathe sufficiently on your own or the lungs have not returned to their full function, ventilators are available. With the help of a tube inserted through the mouth into the windpipe, or a mask, the ventilator can deliver an oxygen-air mixture into the lungs and thus support breathing.

Even if you cannot speak through the breathing tube, we will always enable you to communicate directly with the treatment team and your relatives. In its simplest form, this can be answering yes / no questions by moving the head or eyes. As an alternative, there are also writing boards or electronic devices (tablets, smartphones).

As long as you cannot eat normally, you will be fed through a tube leading through your nose into your stomach (gastric tube) or, in rare cases, through the central venous catheter.

A urinary catheter was inserted into the bladder during surgery. This allows the urine to drain continuously and urine production to be measured. The urinary catheter itself can lead to a feeling of urgency to urinate, but this quickly subsides.

 In the rare case of severe dysfunction of the heart and/or lungs, miniaturized heart-lung machines (ECMO; extracorporeal membrane oxygenation) are available. Driven by pumps, these can take blood from the body via larger catheters, enrich it with oxygen and then return it to the body. Audible or visible alarms provide information about even the smallest changes in the monitored body functions. As a rule, an alarm is intended to draw attention to a specific evolving situation so that appropriate measures can be taken. Only in the rarest of cases are threatening situations indicated. An alarm does not have to unsettle you. Intensive medical treatment remains dependent on devices. The focus of our therapy is always on you and your individual needs and the involvement of your relatives. Our goal is that you regain your strength as quickly as possible so that you can leave our ward again.