Postoperative management of patients undergoing cardiac surgery in Austria

Abstract

SummaryBackgroundNo data are currently available regarding the current clinical practice in postoperative care of cardiac surgical patients in Austria.ObjectiveThe study investigated the current intensive care management concerning hemodynamic monitoring and strategies to treat common perioperative disorders of patients after cardiac surgery in Austria.MethodsA survey consisting of 31 questions was sent to intensivists at all 9 hospitals offering cardiac surgery in Austria.ResultsThe response rate was 100%. The mean number of procedures on cardiopulmonary bypass per centre was 722 ± 223. In the majority of cases postoperative critical care is performed by anesthesiologists. Blood gas analysis, pulse oximetry, electrocardiogram, temperature, central venous pressure, arterial pressure and hourly urine output are de facto standard monitoring in all centers. Transesophageal echocardiography is available in all centers and is frequently used. Crystalloids are the first choice for volume replacement, whereas levosimendan and adrenaline are employed for the treatment of low cardiac output syndrome.ConclusionsThis study provides insights into the current state of postoperative management of cardiac surgical patients in Austria. Standard monitoring as proposed by international guidelines is well established in Austrian intensive care units. Echocardiography is widely seen as a very important tool in the postoperative care of cardiac surgical patients. Knowledge about the status quo of postoperative intensive care management of cardiac surgical patients enables further development of patient care.Electronic supplementary materialThe online version of this article (10.1007/s00508-018-1403-3) contains supplementary material, which is available to authorized users.

Survey on the Updated German S3 Guideline for Intensive Care in Cardiac Surgery Patients

“…Availability, widespread ultrasound-related academic publications, progressive operator experience and training, and the implementation in intensive care guidelines appear to be of central relevance, ensuring the widespread application. 3,[26][27][28][29] Interestingly, the use of the PAC increased, after a decrease following the publication of the previous S3 guideline. The application in pulmonary hypertension is not surprising, but its increased use for cardiac output monitoring was not expected.…”

“…However, an inconsistency regarding the monitoring as well as vasopressor and volume therapy, with varying therapeutic targets, persists. [1][2][3][4] Nevertheless, overall guideline adherence is increasing. 5 In December 2017, the German Society for Thoracic and Cardiovascular Surgery and the German Society for Anaesthesiology and Intensive Care Medicine published an update of the S3 guideline on intensive medical care of cardiac surgical patients: Hemodynamic monitoring and cardiovascular system-an update.…”

Indwelling catheters increase altered mental status and urinary tract infection risk: A retrospective Cohort Study

“…IUCs are used intraoperatively for urine drainage and to measure urine output. Usually, many anesthesiologists measure urine output to maintain optimal blood pressure [ 4 , [6] , [7] , [8] , [11] , [12] , [13] , [14] , [15] , [16] , [17] ]. However, there is little evidence on the management of urine output for improving the prognosis ( e.g.…”

“…During surgery, indwelling urinary catheters (IUCs) are frequently used to assess urine output as an indicator for the optimal blood pressure [ [1] , [2] , [3] , [4] , [5] , [6] , [7] ] and a predictor of postoperative acute kidney injury (AKI) [ [8] , [9] , [10] ]. Worldwide, nearly 80% of all anesthesiologists measure the urine output [ 8 , [11] , [12] , [13] , [14] , [15] , [16] , [17] ]. However, IUCs can cause complications, most frequently catheter-induced urinary tract infections.…”