A case study on management of postoperative cardiorenal syndrome

Background: Postoperative complications contribute to increased mor- tality, length of stay and need for an increased level of care at discharge. In these complex cases, a multiple organ support therapy might be cur- rently seen as a feasible approach. Cardiorenal syndrome (CRS) encom- passes a spectrum of disorders involving both the heart and kidneys in which acute or chronic dysfunction in 1 organ may induce acute or chro- nic dysfunction in the other organ. We present a case of a 71-year-old female who underwent bypass surgery due to coronary artery disease (CAD). After 6 weeks she was admitted to our clinics due to severe pro- gressing dyspnoe, fatigue and weakness. The patient underwent pleural punction, cytology of punctate revealed transudate, no malignant cells. Physyterapeutic evaluation reported: functional assessment measure le- vel - complete asssistance is necessary, balance disorder by Berg scale accounted 0 points, sitting balance by Leahy was 1 point, Rivermade mobility index 1-3. Management approach included strict fluid balance control, 50 mg Torasemid once a day, activization, verticalization.
Methods: On primary survey, her general condition was very severe, patient was lying, passive and frail, respiratory rate was 20/min, oxygen saturation of 90% beyond oxygenotherapy; diuresis 300 ml per day, GFR 40 ml/min (by MDRD). HR was 86 bpm, irregular (atrial fibrillation), TA 90/80 mm Hg. Chest CT demonstrated bothsided hydrothorax and right sided athelectasis with infiltration.
Results: After 2 weeks general condition improved - no dyspnoe, TA 130/80 mm Hg, no need of oxygen, diuresis 1700 ml with no diuretics, GFR (by MDRD formula) 81,87 ml/min, functional assessment measure level- modified independent (requires an assistive device), balance dis- order by Berg scale 10 points, sitting balance by Leahy -3, Rivermade mobility index- 4-7.
Conclusions: This case illustrates the prompt and accurate management of multiorgan damage syndrome (MODS) and frailty secondary to CRS leading to optimal patient outcome.