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

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