Abstract
Background
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.
Methods
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.
Results
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.
Conclusion
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.
Résumé
Introduction
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.
Méthodes
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.
Résultats
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.
Conclusion
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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Article info
Publication history
Published online: October 24, 2011
Accepted:
August 25,
2011
Received:
May 18,
2011
Footnotes
See page 709 for disclosure information.
Identification
Copyright
© 2011 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
