Conclusions
In postoperative cardiac patients, shock is a serious condition with a high morbidity and mortality. Cardiogenic, hypovolemic, obstructive and distributive shock can occur alone or in combination. Early identification of the underlying diseases and understanding the mechanisms at play are key for the correct management of these patients. Prompt resuscitation measures are necessary to reverse the shock state and to avoid permanent organ dysfunction or death. Treatment includes surgical correction when indicated, preload optimisation, maintenance of perfusion pressure, heart rate and arrhythmia control and inotropic support. Although highly effective when used in the right patient at the right dose and the right time, all therapies have the potential for adverse effects. Hence, patient management should assess the benefits against the risks of the various therapeutic interventions.112 This review focuses on the first six hours – the ‘golden hours’. The next phase of ICU management– the ‘silver days’ – will be reviewed in a planned future article for Cardiac Failure Review.