title: Clinical impact of the publication of S3 guidelines for intensive care in cardiac surgery patients in Germany: results from a postal survey.
abstract: BACKGROUND
  The development and implementation of practice guidelines might be an important tool to evaluate the different practices and to consider different local strategies.
  
  
  METHODS
  A postal questionnaire with 37 questions was sent to the leading physicians of 80 intensive care units in Germany, treating patients after cardiothoracic surgery. The survey covered the same core questions on current practice of hemodynamic monitoring, volume replacement, inotropic/vasopressor support, and transfusions before and after the publication of an S3 guideline.
  
  
  RESULTS
  A total of 77.5 % of the completed questionnaires were returned. Monitoring changed to increased use of central venous oxygen saturation (S(cv)O(2)) in 55.1% (2005: 20.9%), end-tidal CO(2)-monitoring 36.2% (2005: 24.3%), and decreased use of the left atrial pressure with 12.3% (2005: 23.3%) and pulmonary artery catheter 47.5% (2005: 58.2%). For volume therapy, there is a decreased use of Hydroxyethyl starch (HES) with 38.7% (2005: 63.4%) and an increased use of crystalloids 41.9% (2005: 22.4%). For inotropes, there is a trend to a decreased use of dopamine with 9.7% (2005: 29.1%, P = 0.074). The clinical relevance of the guidelines was judged 'high' by 43.5% and 'medium' by 50% of the responding physicians; however, change of treatments was reported by one quarter of respondents.
  
  
  CONCLUSIONS
  Despite ongoing variability in the use of monitoring devices, volume replacement and vasopressor/inotrope use in cardiac surgery patients, there have been some changes in the therapy of these patients after publication of the guidelines. Because the guideline has been considered as clinically relevant, further interdisciplinary development and implementation support should be considered.
authors.affiliation: Campus Virchow-Klinikum and Campus Charité Mitte, Department of Anaesthesiology and Intensive Care, Charité-University Medicine, Berlin, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Kastrup
authors.forename: M
authors.initials: M
authors.lastname: Carl
authors.forename: C
authors.initials: C
authors.lastname: Spies
authors.forename: M
authors.initials: M
authors.lastname: Sander
authors.forename: A
authors.initials: A
authors.lastname: Markewitz
authors.forename: U
authors.initials: U
authors.lastname: Schirmer
mesh_terms: D001291:Attitude of Health Personnel; D001784:Blood Gas Analysis; D001810:Blood Volume / Q000502:physiology; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003422:Critical Care / Q000592:standards* / Q000706:statistics & numerical data*; D003627:Data Interpretation, Statistical; D016208:Databases, Factual; D005858:Germany; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D017408:Guidelines as Topic; D019538:Health Care Surveys; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use; D033181:Information Dissemination; D008991:Monitoring, Physiologic; D010952:Plasma Substitutes / Q000627:therapeutic use; D011795:Surveys and Questionnaires; D013903:Thoracic Surgery / Q000592:standards* / Q000706:statistics & numerical data*; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D002316:Cardiotonic Agents; D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D014662:Vasoconstrictor Agents