The Use of Pulmonary Artery Catheters and Echocardiography in the Cardiac Surgery Setting: A Nationwide Italian Survey.

Autor: Sanfilippo F; University Hospital Policlinico G. Rodolico-San Marco, Catania, Italy; Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy. Electronic address: filipposanfi@yahoo.it., Noto A; Division of Anesthesia and Intensive Care, Department of Human Pathology of the Adult and Evolutive Age 'Gaetano Barresi,' Policlinico 'G. Martino,' University of Messina, Messina, Italy., Ajello V; Department of Cardiac Anesthesia, Tor Vergata University Hospital, Rome, Italy., Martinez Lopez de Arroyabe B; Cardiothoracic and Vascular Anesthesia and Intensive Care Unit, Department of Emergency and Intensive Care, University Hospital of Verona, Verona, Italy., Aloisio T; Department of Cardiothoracic and Vascular Anesthesia and Intensive Care Unit (ICU), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato, Milan, Italy., Bertini P; Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy., Mondino M; 'De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy., Silvetti S; Department of Cardiac Anesthesia and Intensive Care, Ospedale Policlinico San Martino IRCCS-IRCCS Cardiovascular Network, Genova, Italy., Putaggio A; School of Anesthesia and Intensive Care, University Magna Graecia, Catanzaro, Italy., Continella C; School of Anesthesia and Intensive Care, University Magna Graecia, Catanzaro, Italy., Ranucci M; Department of Cardiothoracic and Vascular Anesthesia and Intensive Care Unit (ICU), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato, Milan, Italy., Sangalli F; Department of Anesthesia and Intensive Care, Azienda Socio-Sanitaria Territoriale Valtellina e Alto Lario, Sondrio, Italy., Scolletta S; Department of Emergency-Urgency, University Hospital of Siena, Siena, Italy., Paternoster G; Department of Cardiovascular Anesthesia and ICU, San Carlo Hospital, Potenza, Italy.
Jazyk: angličtina
Zdroj: Journal of cardiothoracic and vascular anesthesia [J Cardiothorac Vasc Anesth] 2024 Sep; Vol. 38 (9), pp. 1941-1950. Date of Electronic Publication: 2024 Apr 27.
DOI: 10.1053/j.jvca.2024.04.046
Abstrakt: Objective: Wide variations exist in the use of pulmonary artery catheters (PACs) and echocardiography in the field of cardiac surgery.
Design: A national survey promoted by the Italian Association of Cardio-Thoracic Anesthesiologists and Intensive Care was conducted.
Setting: The study occurred in Italian cardiac surgery centers (n = 71).
Participants: Anesthesiologists-intensivists were enrolled.
Interventions: Anonymous questionnaires were used to investigate the use of PACs and echocardiography in the operating room (OR) and intensive care unit (ICU).
Measurements and Main Results: A total of 257 respondents (32.2% response rate) from 59 centers (83.1% response rate) participated. Use of PACs seems less common in ORs (median insertion in 20% [5-70] of patients), with slightly higher use in ICUs; in about half of cases, it was the continuous cardiac output monitoring system of choice. Almost two-thirds of respondents recently inserted at least one PAC within a few hours of ICU admission, despite its need being largely preoperatively predictable. Protocols regulating PAC insertion were reported by 25.3% and 28% of respondents (OR and ICU, respectively). Transesophageal echocardiography (TEE) was performed intraoperatively in >75% of patients by 86.4% of respondents; only 23.7% stated that intraoperative TEE relied on anesthesiologists. Tissue Doppler and/or 3D imaging were widely available (87.4% and 82%, respectively), but only 37.8% and 24.3% of respondents self-declared skills in these modalities, respectively; 77.1% of respondents had no echocardiography certification, nor were pursuing certification (various reasons); 40.9% had not attended recent echocardiography courses. Lower PAC use was associated with university hospitals (OR: p = 0.014, ICU: p = 0.032) and with lower interventions/year (OR: p = 0.023). Higher independence in performing TEE was reported in university hospitals (OR: p < 0.001; ICU: p = 0.006), centers with higher interventions/year (OR: p = 0.019), and by respondents with less experience in cardiology (ICU: p = 0.046).
Conclusion: Variability in the use of PACs and echocardiography was found. Protocols regulating the use of PACs seem infrequent. University centers use PACs less and have greater skills in TEE. Training and certifications in echocardiography should be encouraged.
Competing Interests: Declaration of competing interest The authors declare no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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