Clinical practice in perioperative monitoring in adult cardiac surgery. is there a standard of care? results from an national survey
| Autor: | Elena Bignami, Elena Frati, Luigi Tritapepe, Paola Moliterni, Marcello Guarnieri, Alessandro Belletti |
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| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Adult
medicine.medical_specialty Cardiotonic Agents medicine.medical_treatment Health Informatics 030204 cardiovascular system & hematology Critical Care and Intensive Care Medicine law.invention 03 medical and health sciences 0302 clinical medicine law Monitoring Intraoperative Surveys and Questionnaires Intensive care medicine Humans Vasoconstrictor Agents Blood Transfusion Assisted Circulation Cardiac Surgical Procedures medicine.diagnostic_test business.industry Hemodynamics Central venous pressure Pulmonary artery catheter Standard of Care 030208 emergency & critical care medicine Perioperative Intensive care unit Cardiac surgery Intensive Care Units Pulse oximetry Anesthesiology and Pain Medicine Blood pressure Italy Anesthesia Fluid Therapy cardiac surgery goal-directed therapy hemodynamic monitoring inotropic drugs intensive care unit adult assisted circulation blood transfusion cardiac surgical procedures cardiotonic agents fluid therapy hemodynamics humans intensive care units italy monitoring intraoperative standard of care surveys and questionnaires vasoconstrictor agents health informatics critical care and intensive care medicine anesthesiology and pain medicine business |
| Popis: | This study was to investigate and define what is considered as a current clinical practice in hemodynamic monitoring and vasoactive medication use after cardiac surgery in Italy. A 33-item questionnaire was sent to all intensive care units (ICUs) admitting patients after cardiac surgery. 71 out of 92 identified centers (77.2 %) returned a completed questionnaire. Electrocardiogram, invasive blood pressure, central venous pressure, pulse oximetry, diuresis, body temperature and blood gas analysis were identified as routinely used hemodynamic monitoring, whereas advanced monitoring was performed with pulmonary artery catheter or echocardiography. Crystalloids were the fluids of choice for volume replacement (86.8 % of Centers). To guide volume management, central venous pressure (26.7 %) and invasive blood pressure (19.7 %) were the most frequently used parameters. Dobutamine was the first choice for treatment of left heart dysfunction (40 %) and epinephrine was the first choice for right heart dysfunction (26.8 %). Half of the Centers had an internal protocol for vasoactive drugs administration. Intra-aortic balloon pump and extra-corporeal membrane oxygenation were widely available among Cardiothoracic ICUs. Angiotensin-converting enzyme inhibitors were suspended in 28 % of the Centers. The survey shows what is considered as standard monitoring in Italian Cardiac ICUs. Standard, routinely used monitoring consists of ECG, SpO2, etCO2, invasive BP, CVP, diuresis, body temperature, and BGA. It also shows that there is large variability among the various Centers regarding hemodynamic monitoring of fluid therapy and inotropes administration. Further research is required to better standardize and define the indicators to improve the standards of intensive care after cardiac surgery among Italian cardiac ICUs. |
| Databáze: | OpenAIRE |
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