postop CICU CV surgery question

[sjamiso1]

I wanted some feedback on a patient I recently worked with. He was a young (under 60) and the surgeon preferred epi as her vasopressor. the HR stayed about 120 and the surgeon was ok with this, did not want to switch pressors ( knowing the SV was low), but the pt's SVO2 was only in the 50s and it would appear that her oxygen Demand was becoming too much in terms of the epi. All in all, he appeared overloaded the whole time. Can someone speak about issues regarding MVRs and need for fluid and which pressor works best for them and when it would be best to diurese them. I have had patients that appear overloaded from OR with CVPs of 25 but are hypotensive. I know MVRs need more fluid due to a boggy ventricle, but can someone speak to other issues relating to this and SVO2 and when to diurese. thank you

[firstinfamily, RN]

It has been a long time since I did ICU and CV surgery, but we use to use the PVR(peripheral vascular resistance) and SVR(systemic vascular resistance) values to know when to wean the pressors. Most of the time the CV surgeons wanted the "tank to be loaded", so, I am not the one to truly answer your question based on the SVO2 levels. It does seem a little odd for them to want the heart rate so high. Maybe you need to just ask the nurse educator to explain his rationale to you!!