This study was to investigate and define what isconsidered as a current clinical practice in hemodynamicmonitoring and vasoactive medication use after cardiacsurgery in Italy. A 33-item questionnaire was sent to allintensive care units (ICUs) admitting patients after cardiacsurgery. 71 out of 92 identified centers (77.2 %) returned acompleted questionnaire. Electrocardiogram, invasiveblood pressure, central venous pressure, pulse oximetry,diuresis, body temperature and blood gas analysis wereidentified as routinely used hemodynamic monitoring,whereas advanced monitoring was performed with pul-monary artery catheter or echocardiography. Crystalloidswere the fluids of choice for volume replacement (86.8 %of Centers). To guide volume management, central venouspressure (26.7 %) and invasive blood pressure (19.7 %)were the most frequently used parameters. Dobutaminewas the first choice for treatment of left heart dysfunction(40 %) and epinephrine was the first choice for right heartdysfunction (26.8 %). Half of the Centers had an internalprotocol for vasoactive drugs administration. Intra-aorticballoon pump and extra-corporeal membrane oxygenationwere widely available among Cardiothoracic ICUs.Angiotensin-converting enzyme inhibitors were suspendedin 28 % of the Centers. The survey shows what is con-sidered as standard monitoring in Italian Cardiac ICUs.Standard, routinely used monitoring consists of ECG,SpO2, etCO2, invasive BP, CVP, diuresis, body tempera-ture, and BGA. It also shows that there is large variabilityamong the various Centers regarding hemodynamic mon-itoring of fluid therapy and inotropes administration. Fur-ther research is required to better standardize and define theindicators to improve the standards of intensive care aftercardiac surgery among Italian cardiac ICUs

Clinical practice in perioperative monitoring in adult cardiac surgery. is there a standard of care? results from an national survey / Bignami, Elena; Belletti, Alessandro; Moliterni, Paola; Frati, Elena; Guarnieri, Marcello; Tritapepe, Luigi. - In: JOURNAL OF CLINICAL MONITORING AND COMPUTING. - ISSN 1387-1307. - 30:3(2016), pp. 347-365. [10.1007/s10877-015-9725-4]

Clinical practice in perioperative monitoring in adult cardiac surgery. is there a standard of care? results from an national survey

Tritapepe, Luigi
2016

Abstract

This study was to investigate and define what isconsidered as a current clinical practice in hemodynamicmonitoring and vasoactive medication use after cardiacsurgery in Italy. A 33-item questionnaire was sent to allintensive care units (ICUs) admitting patients after cardiacsurgery. 71 out of 92 identified centers (77.2 %) returned acompleted questionnaire. Electrocardiogram, invasiveblood pressure, central venous pressure, pulse oximetry,diuresis, body temperature and blood gas analysis wereidentified as routinely used hemodynamic monitoring,whereas advanced monitoring was performed with pul-monary artery catheter or echocardiography. Crystalloidswere the fluids of choice for volume replacement (86.8 %of Centers). To guide volume management, central venouspressure (26.7 %) and invasive blood pressure (19.7 %)were the most frequently used parameters. Dobutaminewas the first choice for treatment of left heart dysfunction(40 %) and epinephrine was the first choice for right heartdysfunction (26.8 %). Half of the Centers had an internalprotocol for vasoactive drugs administration. Intra-aorticballoon pump and extra-corporeal membrane oxygenationwere widely available among Cardiothoracic ICUs.Angiotensin-converting enzyme inhibitors were suspendedin 28 % of the Centers. The survey shows what is con-sidered as standard monitoring in Italian Cardiac ICUs.Standard, routinely used monitoring consists of ECG,SpO2, etCO2, invasive BP, CVP, diuresis, body tempera-ture, and BGA. It also shows that there is large variabilityamong the various Centers regarding hemodynamic mon-itoring of fluid therapy and inotropes administration. Fur-ther research is required to better standardize and define theindicators to improve the standards of intensive care aftercardiac surgery among Italian cardiac ICUs
2016
cardiac surgery; goal-directed therapy; hemodynamic monitoring; inotropic drugs; intensive care unit; adult; assisted circulation; blood transfusion; cardiac surgical procedures; cardiotonic agents; fluid therapy; hemodynamics; humans; intensive care units; italy; monitoring, intraoperative; standard of care; surveys and questionnaires; vasoconstrictor agents; health informatics; critical care and intensive care medicine; anesthesiology and pain medicine
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Clinical practice in perioperative monitoring in adult cardiac surgery. is there a standard of care? results from an national survey / Bignami, Elena; Belletti, Alessandro; Moliterni, Paola; Frati, Elena; Guarnieri, Marcello; Tritapepe, Luigi. - In: JOURNAL OF CLINICAL MONITORING AND COMPUTING. - ISSN 1387-1307. - 30:3(2016), pp. 347-365. [10.1007/s10877-015-9725-4]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1089375
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