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Supraventricular tachycardia after coronary artery bypass grafting surgery and fluid and electrolyte variables
B R Nally1, S B Dunbar, M Zellinger
1Nell Hodgson Woodruff School of Nursing, Emory University Hospital, Atlanta, GA, USA.
Insights
Fluid and electrolyte imbalances, particularly after surgery, are linked to supraventricular tachycardia (SVT) development in patients undergoing coronary artery bypass grafting (CABG). Monitoring these variables can improve patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Critical Care Medicine
- Electrolyte Physiology
Background:
- Supraventricular tachycardia (SVT) is a potential complication following coronary artery bypass grafting (CABG).
- Understanding factors contributing to SVT post-CABG is crucial for patient management.
Purpose of the Study:
- To investigate the association between fluid and electrolyte derangements and the incidence of SVT in patients after CABG surgery.
Main Methods:
- Retrospective chart review of 80 patients (40 with SVT, 40 without) undergoing initial CABG.
- Data collected included demographics, medical history, medications, and postoperative fluid/electrolyte variables (potassium, calcium, magnesium, IV intake, urine output, chest tube drainage).
Main Results:
- Older patients and those with a prior history of SVT had a higher incidence of postoperative SVT.
- Increased SVT risk was associated with intravenous potassium bolus administration, significant chest tube blood loss (>100 ml/hr), and high urine output (>300 ml/hr for >9 hrs).
- The majority of SVT events (62%) occurred 24-48 hours post-surgery.
Conclusions:
- Fluid and electrolyte shifts are significant indicators for SVT development in post-CABG patients.
- Early identification and management of these imbalances can potentially improve patient recovery and hemodynamic stability.
Objective:
To explore the relationship between fluid and electrolyte variables and the development of supraventricular tachycardia (SVT) after coronary artery bypass grafting (CABG) surgery.
Design:
Retrospective chart review. Random selection from a list obtained from the medical records department and with use of the International Classification of Diseases code to identify patients undergoing their initial CABG.
Setting:
Medical records department of a southeastern 600-bed urban referral hospital with a large cardiovascular surgical program.
Patients:
Forty patients experiencing SVT and 40 patients not experiencing SVT during their stay in an intensive care unit after CABG.
Outcome Measures:
Fluid and electrolyte variables and the development of SVT in the intensive care unit after CABG.
Variables:
Data collected included preoperative demographic variables such as age and gender; previous history of SVT, congestive heart failure, cardiac arrest, previous surgery, diabetes, hypertension, valve disease, tobacco use, obesity; preoperative and postoperative medications; postoperative laboratory values of potassium, calcium, and magnesium; intravenous intake; hourly urine output; and chest tube drainage.
Results:
Demographic variables revealed that patients with SVT were older (p = 0.001) and had a higher incidence of preoperative SVT (p = 0.04). Although groups did not differ by numbers of patients with high or low potassium, calcium, or magnesium, patients receiving additional intravenous potassium by bolus after surgery had a higher incidence of SVT (p = 0.02). Patients who lost blood via the chest tube at a rate greater than 100 ml per hour for at least 1 hour after surgery had a higher incidence of SVT (p = 0.02). Patients with a urine output greater than 300 ml per hour for longer than 9 hours had an increased incidence of SVT (p = 0.02). In the patients experiencing SVT, 62% had it occur 24 to 48 hours after surgery.
Conclusions:
These data suggest that shifts in fluid and electrolytes may be important characteristics of patients in whom SVT will develop, which could lead to better identification and nursing management of SVT and improve hemodynamic status, patient recovery, and cost after CABG.