CVICU I

Immediately following my reigonal anesthesia rotation, I went to the cardiovascular ICU. Known as one of the toughest rotations for anesthesia residents, I had a little bit of dread. What scared me the most was the acuity of the patients in the unit. Although we have the usual "straightforward" postoperative cardiac patients after a bypass surgery or simple valve replacement, we also get extremely sick patients after redo-sternotomies, aortic root surgeries, heart and lung transplants, and other complex surgeries. It's not the simple patients recovering from surgery that scare me but that minority of patients who are actively dying.

We have about 20 patients on the census at any one time. The majority of them are post-op from cardiac surgery. They include some of the more tertiary-center surgeries like minimally invasive valve replacements, transcutaneous transfemoral valve replacements, and large aortic surgeries. These patients either do really well or really poorly. While minimally invasive or transcutaneous surgeries are smaller traumas to the body, the patients we get have a lot of comorbidities. Their heart may do great, but their severe COPD, pre-operative renal insufficiency, chronic pain, or altered mental status hamper the recovery. The aortic surgeries are the opposite; surgeries are a huge ordeal with many hours on bypass with extreme cooling of the body. But these patients with Marfan syndrome tend to be young and healthy. Some of them recover in a few days and others have a long intensive care unit course. The cardiac surgery service also accepts aortic dissections from the community who come to the intensive care unit for blood pressure management and determination of a therapeutic plan. These vary a lot in acuity; some are sent for a mild descending Type B dissection which is non-operative so we put them on blood pressure medications and get them out of the ICU quickly. Others have to go emergently to the operating room without medical optimization; the post-operative critical care course is always rocky. The wide range of patients, surgeries, and acuity pose a constant challenge for the cardiothoracic ICU team.