A survey of standardized management protocols after coronary artery bypass grafting surgery in Canadian intensive care units.
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.


CONCLUSIONS
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.
Department of Cardiac Surgery, Montreal Heart Institute/Université de Montréal, Division of Critical Care, Hôpital du Sacré-Coeur/Université de Montréal, Montréal, Québec, Canada. yoanlamarche@gmail.com
Yoan
Y
Lamarche
Demetrios
D
Sirounis
Rakesh C
RC
Arora
D002170:Canada / Q000453:epidemiology; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000601:surgery*; D003325:Coronary Care Units / Q000592:standards*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D011182:Postoperative Care / Q000592:standards*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D017410:Practice Guidelines as Topic / Q000592:standards*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome