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Abstract
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Background and Aims The postoperative period is one of the most critical moments in a patient’s recovery process mortality is a lot higher than actual intraoperative. Hypotension is related to significant damage that could increase the risk of myocardial injury, mortality, and kidney injury. Therefore, controlling hypotension correctly in the postoperative period is essential.
Methods We present two patients; the first is a male 56 years old who underwent emergency cardiac surgery for an ascending aorta dissection, and the second, is a 65-year-old male who was operated on for a triple cardiac bypass. After surgery, they both get admitted into the critical care unit for postoperative care. Two hours after surgery the present persistent hypotension. To correctly treat the cause of the hypotension we decided to perform POCUS (point-of-care-ultrasound) following the algorithm proposed by Rodenas et al. Results are presented in Table 1.
Results Patient 2 develop correctly after the administration of continuous intravenous perfusion of norepinephrine. Patient 1 responded well to volume, but an hour after, hypotension started again, not responding to liquid administration, therefore we performed POCUS to orientate the origin. The echocardiographic evaluation showed us that the small pericardial effusion was now a pericardial tamponade (20mm). Immediate surgery was indicated.
Pulsated Doppler at the suprahepatic vein showing inversion of the S wave
Pulsated Doppler at the Porta vein showing increased pulsatility
Integral velocity time index at the aorta exit (IVTI Ao), Left Ventricle (LV), Right Ventricle (RV), and Systolic Volume Variation (SVV)
Conclusions In these two case reports, we can see the importance of using echography as a complementary tool to correctly orientate the cause of hypotension in the postoperative period, since it gives us valuable information in clinical practice. Using it in conjunction with regular monitoring will permit better care in this critical time.