Management of hemodynamics in the postbypass period.

 Proper management of patients in the post bypass period involves continuous assessment of five hemodynamic variables as summarized in Figure. These are preload, rate, rhythm, contractility, and afterload.

 CPB, cardiopulmonary bypass; IABP, intra-aortic balloon pump.

Although profound cardiovascular collapse after the bypass is uncommon, it is likely that a technical problem (ischemia, valvular dysfunction) or severe metabolic derangement exists, and TEE can help make the correct diagnosis. If cardiovascular deterioration is unresponsive to maximal inotropic therapy and no immediate reversible cause can be identified, then reinstitution of CPB will be necessary.