An Insight about Management of Mediastinal Bleeding

Abstract

Background: The roadmap for management of postoperative bleeding is reviewd and summarized here in this review. Except for hemodynamically unstable patients, we follow conservative management is carried on by transfusion of fresh blood products, factor VII, and tranexmic acid (1–2 g). Blood transfusion is accomplished according to liberal strategy. Packed RBCs are given if Hb is less than 8 g/dL with mixed venous saturation > 60% and if Hb is < 10 g/dL with mixed venous saturation < 60%. During the first 48 h after primary surgery, no definite time to switch from conservation to exploration as long as hemodynamics and hematological tests were controlled. Re-sternotomy is carried out in OR except for patients with tamponade or cardiac arrest where it is done emergently bedside in ICU. The decision of re-exploration is a teamwork decision involving cardiac surgery and ICU physicians and finally approved by the operating surgeon. Emergency re-exploration is indicated for exsanguinating hemorrhage or tamponade with incipient cardiac arrest. Patients who need to undergo resternotomy have poorer outcomes than those who do not. These outcomes include: prolonged ICU and hospital stay; acute kidney injury; mediastinal infection; increased healthcare costs; and death. A previous single-centre study showed that resternotomy was associated with a doubling of expected mortality, respiratory failure and renal failure requiring renal replacement therapy.