Intenzivistička skrb bolesnika nakon transplantacije srca

master's thesis

• Title (english): Intensive care management of patients after heart transplantation
• Author: Petra Čepić
• Mentor: Sanja Konosić (mentor)
• Committee member: Slobodan Mihaljević (predsjednik povjerenstva)
• Committee member: Dinko Tonković (član povjerenstva)
• Committee member: Sanja Konosić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Anaesthesiology, Resuscitation and Intensive Care in Surgical Specialities); Zagreb
• Defense date and country: 2023-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Anesthesiology and Reanimatology

Abstract

Transplantacija srca je metoda liječenja pacijenata s terminalnim srčanim zatajenjem čije je očekivano trajanje života manje od godinu dana. Godišnje se u svijetu transplantira preko 5500 srca, s preživljenjem od 91% u prvoj godini nakon operacije i ukupnim medijanom preživljenja 12 godina (1). Mortalitetni rizik za pacijenta najveći je neposredno nakon transplantacije, za vrijeme boravka u jedinici intenzivne njege. Iako je poslijeoperativna skrb za sve pacijente nakon kardiokirurške operacije slična, postoje određene posebitosti i komplikacije kod zbrinjavanja primaoca srčanog presatka. Nakon transplantacije srca očekivana je određena mjera hemodinamske nestabilnosti. Nužna je optimizacija pacijentovog predopterećenja, naknadnog opterećenja i kontraktilnosti kako bi se postigla optimalna srčana funkcija i izbjeglo primarno zatajenje presatka. Farmakološka potpora uključuje inotrope za održavanje kontraktilnosti i funkcije miokarda, koloidnu i kristaloidnu nadoknadu volumena, optimizaciju diureze i vazopresore za podizanje naknadnog opterećenja i održavanje srednjeg arterijskog tlaka u fiziološkom rasponu. U ovom radu opisane su navedene smjernice za održavanje funkcije presađenog srca, strategije imunosupresije, te osvrt na najčešće komplikacije za vrijeme boravka u jedinici intenzivne njege.

Abstract (english)

Heart transplantation is a therapy method for patients with end-stage heart failure whose life expectancy is less than one year. Over 5,500 hearts are transplanted annually in the world, with a survival rate of 91% in the first year after surgery and an overall median survival of 12 years (1). The main mortality risk for the patient is immediately after transplantation, during the stay in the intensive care unit. Although postoperative care for all patients after cardiac surgery is similar, there are certain peculiarities and complications in the care of post-transplant patients. Certain measure of hemodynamic instability is expected after heart transplantation. Optimization of the patient's preload, afterload, and contractility is necessary to achieve optimal cardiac function and avoid primary graft failure. Pharmacological support includes inotropes to maintain myocardial contractility and function, colloidal and crystalloid volume replacement, diuresis optimization, and vasopressors to increase afterload and maintain mean arterial pressure in the physiological range. This paper describes the guidelines for maintaining the function of a transplanted heart, immunosuppression strategies, and a review of the most common complications during a stay in the intensive care unit.

• Keywords: transplantacija srca; jedinica intenzivne njege; hemodinamika; imunosupresija; primarna disfunkcija presatka
• Keywords (english): heart transplantation; intensive care unit; hemodynamics; immunosuppression; primary graft dysfunction
• Language: croatian
• URN:NBN: urn:nbn:hr:105:265210
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-10-23 12:51:06