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Adult cardiac surgery and method of perioperative care (Fifth edition): Part 2

(BQ) Continued part 1, part 2 of the document Adult cardiac surgery and method of perioperative care (Fifth edition) has contents: Fluid management, renal, metabolic, and endocrine problems, cardiovascular management, respiratory management, mediastinal bleeding, and other contents. Invite you to refer. | Adult cardiac surgery and method of perioperative care (Fifth edition): Part 2 CHAPTER 9 Mediastinal Bleeding Overview.347 Etiology of Mediastinal Bleeding348 Prevention of Perioperative Blood Loss: Blood Conservation Measures. 351 Assessment of Bleeding in the ICU 356 Management of Mediastinal Bleeding .363 Blood Transfusions: Red Cells 367 Blood Components, Colloids, and Blood Substitutes 369 Mediastinal Reexploration for Bleeding or Tamponade 371 Technique of Emergency Resternotomy373 OVERVIEW 347 9 Mediastinal Bleeding I. Overview A. The use of cardiopulmonary bypass (CPB) during cardiac surgical procedures causes a significant disruption of the coagulation system that may contribute to a coagulopathy of varying degrees.1 In addition to hemodilution from a crystalloid prime, which reduces levels of clotting factors and platelets, contact of blood with the extracorporeal circuit activates platelets and the extrinsic and intrinsic coagulation systems, and triggers fibrinolysis. In fact, systemic heparinization alone causes platelet dysfunction and induces fibrinolysis.2 In addition, cell-saving devices that are routinely used for red cell salvage eliminate platelets and coagulation factors from the blood. B. Off-pump coronary artery bypass surgery (OPCAB) avoids hemodilution and mini- mizes platelet activation, and is associated with reduced usage of blood products.3 The ability of the antifibrinolytic agents to reduce bleeding suggests that low-grade fibrino- lysis is still present.4 .