Succeses in the CVICU

As a high-risk high-stakes environment, the CVICU has its setbacks, but also its triumphs and successes. A man with severe interstitial lung disease gets a bilateral lung transplant. The lungs have had a significant ischemic time and aren't all that great; nevertheless, the patient needs them; he's on 6 liters of home oxygen and feels short of breath all the time. Furthermore, the operation is complicated by a need to emergently crash onto bypass because of bleeding on entering the chest. All of these portend a very rocky course, and indeed, the patient had a long ICU stay. Weeks on the ventilator made him incredibly weak, yet he was very motivated to get better. By the end of the month, he was walking with physical therapy while on a ventilator, and when I checked back after the rotation, he had successfully rehabilitated off breathing support.

A young man with a history of rheumatic fever collapses in a mall. He is rushed in and a diagnosis of acute mitral valve rupture is made. He is near death, requiring code doses of epinephrine. Rushed to the operating room, he undergoes a mitral valve replacement. His heart has suffered such an injury that he is put on ECMO while the heart recovers. A machine takes over the job of the heart, circulating the blood in his body, while his heart recovers. To transition him off ECMO, he is given an intra-aortic balloon pump that offloads stress from the heart. After a week of intensive care, all these devices are removed, he is extubated, and he survives this unexpected cardiac catastrophe.

Day to day, we also have our routine smooth post-operative patients. I've seen a patient undergo a replacement of his entire aotic arch for Marfan syndrome and leave the ICU within 24 hours of arriving. I've seen a single lung transplant get extubated within two hours and transferred to the floor within sixteen. We have our patients who come in with Type B aortic dissections who have their antihypertensives adjusted and cocaine-use counseled. Many of the quick in-and-out patients don't stick with my memory because they do as we expect, smoothly and uneventfully.