Vía clínica de recuperación intensificada en cirugía cardiaca. Documento de consenso de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR), la Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE) y la Asociación Española de Perfusionistas (AEP)

Pajares, María Azucena; Margarit, A. S.; García-Camacho, Carlos; García-Suárez, Jessica; Mateo, E.; Castaño, Mario; Forte, C. López; Menéndez, José López; Gómez, M.; Soto, Marı́a José; Veiras, S.; Martin, E; Castaño, Beatriz; Palanca, Sara López; Gabaldón, Tania; Acosta, J.; Cruz, J. Fernández; López, Antonio Rezusta; García, Mercedes; Acuña, Carlos; Moreno, Jesús; Osseyran, Faisa; Vives, Marc; Pradas, Consuelo Saucedo; Aguilar, E.; Mínguez, Almudena Moreno; Bustamante‐Munguira, Juan; Gutiérrez, E.; Llorens, R.; Galán, J.; Blanco, Jacobo Bacariza; Vicente, R.

doi:10.1016/j.redar.2020.11.005

Cited by 7 publications

(2 citation statements)

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“…The multimodal, multidisciplinary and continued-care approach of these protocols-which are applied before, during and after surgery-aim to improve quality of care and perioperative evolution, and to aid in early recovery. [1] Patients who undergo cardiac surgery are exposed to events and procedures that can become risk factors for increased morbidity and mortality, including but not limited to: progressive deterioration of nutritional status due to decreasing daily intake and preoperative IMPORTANCE This study provides evidence pointing to benefi ts of improved recovery protocols in cardiac surgery, which may lead to their implementation in Cuban heart surgery units and those of hospitals in limited-resource settings.…”

Section: Introductionmentioning

confidence: 97%

“…fasting; anticoagulation procedures during the intraoperative period; prolonged periods of aortic clamping and cardiac arrest; extracorporeal circulation including the potential development of an infl ammatory response syndrome; blood transfusions; intensive pharmacological support or mechanical support for lowoutput syndrome; and late postoperative nutritional support. [1][2][3] Improved recovery protocols propose comprehensive treatment with actions that cover the entire perioperative period and are designed to ameliorate the negative effects of these factors, and hence they are recommended for implementation in cardiac surgery units.…”

Section: Introductionmentioning

confidence: 99%

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Improved Recovery Protocols in Cardiac Surgery: A Systematic Review and Meta-Analysis of Observational and Quasi-Experimental Studies

2021

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INTRODUCTION Improved recovery protocols were implemented in surgical specialties over the last decade, which decreased anesthetic and surgical stress and the incidence of perioperative complications. However, these recovery protocols were introduced more slowly for cardiac surgeries. The most frequent complications in cardiac surgery are related to patient clinical status and the characteristics of the surgical procedures involved, which are becoming more varied and complex every day. The fi rst version of the enhanced recovery program for cardiac surgery was published in 2019, but its recommendations were based on only a few studies, and scant research has evaluated its implementation. Randomized and controlled clinical trials for these protocols are scarce, so research that summarizes the results of studies with other methodological designs are useful in demonstrating their benefi ts in cardiovascular surgery services in Cuba and in other limited-resource settings.OBJECTIVE Estimate the effectiveness of improved recovery protocols in the perioperative evolution of patients undergoing cardiac surgery. METHODSWe performed a systematic review and metaanalysis according to the guidelines of manual 5.1.0 for reviews of the Cochrane library. We included observational and quasiexperimental studies published from January 2015 through May 2020 that compared enhanced recovery protocols with conventional treatments in patients older than 18 years, and used a quality score to evaluate them. We used the following sources: the Cochrane Library, PubMed, LILACS, SciELO, EBSCO, Google Scholar, Web of Science, Clinical Key, ResearchGate and HINARI. The following keywords were used for the database searches in English: ERAS, protocols and cardiac surgery, enhanced recovery after cardiac surgery, ERACS, clinical pathway recovery and cardiac surgery, perioperative care and cardiac surgery. We used the following search terms for databases in Spanish: protocolos de recuperación precoz and cirugía cardiaca, protocolos de recuperación mejorada and cirugía cardiaca, cuidados perioperatorios and cirugía cardiaca, programas de recuperación precoz and cirugía cardiovascular. Methodological quality of included investigations was evaluated using the surgical research methodology scale. Meta-analyses were performed for perioperative complications, intensive care unit and hospital stays, and hospital readmission within 30 days of surgery. We calculated effect sizes of the interventions and the corresponding 95% confi dence intervals. We used mean differences and confi dence intervals for continuous variables, and for qualitative variables we calculated relative risk (RR). Random effects analysis was used. Heterogeneity of the studies was assessed using the Q statistic and the I 2 statistic. RESULTSWe selected 15 studies (a total of 5059 patients: study group, n = 1706; control group, n = 3353). The average quality score for the 15 articles included was 18.9 (out of a maximum of 36 according to the scale) and 66.6% had a score ≥18. With improv...

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Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%