Clinical research| Volume 27, ISSUE 6, P705-710, November 2011

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A Survey of Standardized Management Protocols After Coronary Artery Bypass Grafting Surgery in Canadian Intensive Care Units

Published:October 24, 2011DOI:



      Patients undergoing surgical coronary revascularization typically recover in an intensive care unit where many aspects of patient care are protocolized despite absence of widespread evidence-based guidelines on perioperative management. It was hypothesized that the postoperative management strategies varied significantly among units.


      We surveyed 31 Canadian cardiac surgical intensive care units to obtain their postoperative standing orders. Management strategies after coronary bypass surgery were compared to identify areas of variability in the care of frequent clinical scenarios.


      In all, 28 units (90%) responded, and 26 sites (84%) reported using at least 1 formal postoperative protocol. All but 1 of the responding units (96%) have specific orders for coronary artery bypass graft patients. Orders for allogeneic red blood cell transfusion threshold, postoperative extubation pathway, analgesia, and atrial fibrillation management were present in 40%, 74%, 60%, and 57% of the responding units, respectively. A protocolized trigger to notify the surgeon was specified for bleeding and hypotension in 75% and 35% of the centres, respectively. A standing order for aspirin administration was used in 91% of the centres, and statin administration was mentioned in 41%. Despite the frequent use of protocols in postoperative care, the content of the protocol varied significantly from centre to centre.


      The majority of Canadian centres use at least 1 formal protocol for the care of the postoperative coronary revascularization patient. There is, however, significant variability in these management protocols. Future studies should examine whether implementation of standardized protocols improves outcomes and what treatment strategies are optimal in postoperative cardiac surgical patients.



      Les patients subissant une chirurgie de revascularisation coronarienne se rétablissent notamment dans une unité de soins aux malades en phase critique où plusieurs aspects des soins aux patients sont régis par un protocole malgré l'absence de lignes directrices sur la gestion périopératoire fondées sur la preuve. On avançait l'hypothèse que les stratégies de gestion postopératoire variaient de manière significative d'une unité à l'autre.


      Nous avons effectué un sondage auprès de 31 unités canadiennes de soins intensifs de chirurgie cardiaque pour obtenir leurs consignes postopératoires. Les stratégies de gestion après un pontage aortocoronarien ont été comparées pour identifier les zones de variabilité dans les soins de scénarios cliniques fréquents.


      En tout, 28 unités (90 %) ont répondu, et 26 sites (84 %) ont rapporté utiliser au moins un (1) protocole postopératoire formel. Tout sauf un (1) des unités répondantes (96 %) ont des consignes spécifiques pour les patients ayant eu un pontage aortocoronarien. Les consignes pour les seuils de transfusion allogénique des globules rouges, l'extubation postopératoire, l'analgésie et la gestion de la fibrillation auriculaire ont été présentes dans 40 %, 74 %, 60 % et 57 % des unités répondantes, respectivement. Un protocole spécifie d'aviser le chirurgien dans le cas de saignement et d'hypotension dans 75 % et 35 % des centres, respectivement. Une consigne pour l'administration de l'aspirine a été utilisée dans 91 % des centres, et l'administration de la statine a été mentionnée dans 41 %. En dépit de l'utilisation fréquente des protocoles en soins postopératoires, le contenu du protocole a varié significativement d'un centre à l'autre.


      La majorité des centres canadiens utilisent au moins un (1) protocole formel pour les soins postopératoires des patients ayant subi une revascularisation coronarienne. Cependant, la variabilité est significative dans ces protocoles de gestion. Des études ultérieures devraient examiner si la mise en place de protocoles standardisés améliorerait les résultats et quelles stratégies de traitement seraient optimales pour les patients après la chirurgie cardiaque.
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