CVICU III

The last set of patients in the CVICU are the post-transplant patients. We do a good number of heart and lung transplants, and their clinical course can be quite variable. Single lung transplants, especially if they are done off bypass, tend to recover quickly. Without the physiologic insult of bypass, these patients have fewer bleeding problems, wake up quickly, need fewer vasoactive drips, and leave the unit quickly. If they have an epidural for pain management, they end up being the least complex patients we have. The ICU course of a double lung transplant, in contrast, can vary quite a bit. Depending on the quality of the transplant lungs, the length of bypass time, and the other comorbidities, these patients can have a quick extubation and smooth course or be intubated for weeks heading for a tracheostomy. The fluid and pressor management can be tricky, and sometimes we sacrifice other organ systems like the kidneys to keep the lungs alive. Similarly, our heart transplant patients have quite individual clinical courses. Some come out on high dose pressors with an intra-aortic balloon pump, and weaning the cardiovascular support can be really hard. With a long bypass time, patients can have complications with bleeding, delirium, and renal failure, so a lot of it depends on the skill of the surgeon and technical difficulty of the transplant. The variable clinical course really engages our medical assessment, decision-making, and treatment plan.