title: Clinical practice in perioperative monitoring in adult cardiac surgery: is there a standard of care? Results from an national survey.
abstract: This study was to investigate and define what is considered as a current clinical practice in hemodynamic monitoring and vasoactive medication use after cardiac surgery in Italy. A 33-item questionnaire was sent to all intensive care units (ICUs) admitting patients after cardiac surgery. 71 out of 92 identified centers (77.2 %) returned a completed questionnaire. Electrocardiogram, invasive blood pressure, central venous pressure, pulse oximetry, diuresis, body temperature and blood gas analysis were identified as routinely used hemodynamic monitoring, whereas advanced monitoring was performed with pulmonary artery catheter or echocardiography. Crystalloids were the fluids of choice for volume replacement (86.8 % of Centers). To guide volume management, central venous pressure (26.7 %) and invasive blood pressure (19.7 %) were the most frequently used parameters. Dobutamine was the first choice for treatment of left heart dysfunction (40 %) and epinephrine was the first choice for right heart dysfunction (26.8 %). Half of the Centers had an internal protocol for vasoactive drugs administration. Intra-aortic balloon pump and extra-corporeal membrane oxygenation were widely available among Cardiothoracic ICUs. Angiotensin-converting enzyme inhibitors were suspended in 28 % of the Centers. The survey shows what is considered as standard monitoring in Italian Cardiac ICUs. Standard, routinely used monitoring consists of ECG, SpO2, etCO2, invasive BP, CVP, diuresis, body temperature, and BGA. It also shows that there is large variability among the various Centers regarding hemodynamic monitoring of fluid therapy and inotropes administration. Further research is required to better standardize and define the indicators to improve the standards of intensive care after cardiac surgery among Italian cardiac ICUs.
authors.affiliation: Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy. bignami.elena@hsr.it.
authors.forename: Elena
authors.initials: E
authors.lastname: Bignami
authors.affiliation: Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Belletti
authors.affiliation: Department of Cardiovascular Sciences, Centro Cardiologico Monzino, IRCCS, University of Milan, Via Carlo Parea 4, 20138, Milan, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Moliterni
authors.affiliation: Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Frati
authors.affiliation: Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Guarnieri
authors.affiliation: Department of Anesthesiology and Intensive Care, University of Rome, "La Sapienza", Viale del Policlinico 155, 00161, Rome, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Tritapepe
mesh_terms: D000328:Adult; D001243:Assisted Circulation; D001803:Blood Transfusion; D006348:Cardiac Surgical Procedures / Q000592:standards*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D005440:Fluid Therapy / Q000592:standards; D006439:Hemodynamics; D006801:Humans; D007362:Intensive Care Units; D007558:Italy; D016343:Monitoring, Intraoperative / Q000592:standards*; D059039:Standard of Care; D011795:Surveys and Questionnaires; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D002316:Cardiotonic Agents; D014662:Vasoconstrictor Agents
keywords: Cardiac surgery; Goal-directed therapy; Hemodynamic monitoring; Inotropic drugs; Intensive care unit