title: The impact of an algorithm on the optimization of beta-blockers after cardiac surgery.
abstract: OBJECTIVE
  To evaluate the impact of a simple written algorithm of early postoperative beta-blocker administration on daily practices.
  
  
  METHODS
  A prospective, single center observational study.
  
  
  METHODS
  A 16-bed cardiac surgical intensive care unit in a university teaching hospital.
  
  
  METHODS
  One hundred twenty-five consecutive adult patients chronically treated with beta-blockers and scheduled for conventional cardiac surgery.
  
  
  METHODS
  Two successive 4-month phases: Phase 1 = uncontrolled early postoperative beta-blocker administration (n = 73) and phase 2 = beta-blocker administration by an institutional written algorithm using incremental doses of bisoprolol and/or esmolol (n = 52).
  
  
  RESULTS
  The main endpoint was the number of patients receiving beta-blockers on the morning of postoperative day 1. Secondary endpoints were the number of patients receiving beta-blockers on the morning of postoperative day 1 and reaching the targeted therapeutic goal and the incidence of postoperative atrial fibrillation in the intensive care unit. A 79% increase in the number of patients receiving beta-blockers on the morning of postoperative day 1 (42% v 75%, p<0.001) was observed during the second phase of the study. The number of patients receiving beta-blockers on the morning of postoperative day 1 and reaching the targeted therapeutic goal was increased significantly by 127% (33% v 75%, p<0.001). The incidence of atrial fibrillation was similar between both phases of the study: 37% versus 31%, p = 0.567.
  
  
  CONCLUSIONS
  A simple written algorithm markedly improved early postoperative continuation of beta-blockers in chronically treated patients undergoing conventional cardiac surgery.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, CHU de Caen, Faculty of Medicine, University of Caen, Caen, France. Electronic address: fellahi-jl@chu-caen.fr.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Fellahi
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, CHU de Caen, Faculty of Medicine, University of Caen, Caen, France.
authors.forename: William
authors.initials: W
authors.lastname: Fornier
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, CHU de Caen, Faculty of Medicine, University of Caen, Caen, France.
authors.forename: Marc-Olivier
authors.initials: MO
authors.lastname: Fischer
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, CHU de Caen, Faculty of Medicine, University of Caen, Caen, France.
authors.forename: Dan
authors.initials: D
authors.lastname: Bohadana
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, CHU de Caen, Faculty of Medicine, University of Caen, Caen, France.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Gerard
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, CHU de Caen, Faculty of Medicine, University of Caen, Caen, France.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Hanouz
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000517:prevention & control*; D011446:Prospective Studies
chemical_list: D000319:Adrenergic beta-Antagonists
keywords: beta-blockade, postoperative arrhythmias; cardiac surgery; chronic beta-blocker treatment; postoperative atrial fibrillation