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

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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.

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Acknowledgments

We acknowledge all the Centers that participated in our survey. The full list of responding Centers is available in the “Appendix”.

Conflict of interest

The Authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy

    Elena Bignami, Alessandro Belletti, Elena Frati & Marcello Guarnieri

  2. Department of Cardiovascular Sciences, Centro Cardiologico Monzino, IRCCS, University of Milan, Via Carlo Parea 4, 20138, Milan, Italy

    Paola Moliterni

  3. Department of Anesthesiology and Intensive Care, University of Rome, “La Sapienza”, Viale del Policlinico 155, 00161, Rome, Italy

    Luigi Tritapepe

Authors
  1. Elena Bignami
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  2. Alessandro Belletti
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  3. Paola Moliterni
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  4. Elena Frati
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  5. Marcello Guarnieri
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Corresponding author

Correspondence to Elena Bignami.

Additional information

On behalf of the SIAARTI Study Group on Cardiothoracic and Vascular Anesthesia.

Appendices

Appendix 1

Appendix 2

Centers that contributed to this survey, listed in alphabetical order of town:

  1. 1.

    Ospedali Riuniti Umberto I-Lancisi-Salesi, Ancona

  2. 2.

    A.O. S. G. Moscati, Avellino

  3. 3.

    A.O.U. Policlinico Giovanni XXIII, Bari

  4. 4.

    Anthea Hospital, Bari

  5. 5.

    Casa di Cura S.Maria, Bari

  6. 6.

    Ospedali Riuniti, Bergamo

  7. 7.

    Clinica Humanitas Gavazzeni, Bergamo

  8. 8.

    Policlinico S.Orsola-Malpighi, Bologna

  9. 9.

    Villa Torri Hospital, Bologna

  10. 10.

    Spedali Civili, Brescia

  11. 11.

    Istituto Ospedaliero Fondazione Poliambulanza, Brescia

  12. 12.

    Istituto Clinico San Rocco, Brescia

  13. 13.

    Casa di Cura Pineta Grande, Castelvolturno

  14. 14.

    A.O.G.Brotzu, Cagliari

  15. 15.

    A.O.U. Vittorio Emanuele, Catania

  16. 16.

    Policlinico Universitario Magna Graecia, Catanzaro

  17. 17.

    A.O. S. Croce e Carle, Cuneo

  18. 18.

    A.O.U. Careggi, Firenze

  19. 19.

    A.O.U. S.Martino, Genova

  20. 20.

    P. O. Vito Fazzi, Lecce

  21. 21.

    Città di Lecce Hospital, Lecce

  22. 22.

    P.O. Alessandro Manzoni, Lecco

  23. 23.

    A.O. Ospedale Civile, Legnano

  24. 24.

    A.O. Carlo Poma, Mantova

  25. 25.

    Ospedale del Cuore G. Pasquinucci, Massa

  26. 26.

    A.O. Ospedali RiunitiPapardo-Piemonte, Messina

  27. 27.

    Istituto Clinico Sant’Ambrogio, Milano

  28. 28.

    A.O. Niguarda Ca’ Granda, Milano

  29. 29.

    Ospedale Luigi Sacco, Milano

  30. 30.

    IRCCS Centro Cardiologico Monzino, Milano

  31. 31.

    IRCCS Ospedale San Raffaele, Milano

  32. 32.

    IRCCS Istituto Clinico Humanitas, Milano (Rozzano)

  33. 33.

    IRCCS Policlinico S.Donato, Milano (San Donato)

  34. 34.

    IRCCS MultiMedica, Milano (Sesto S.Giovanni)

  35. 35.

    Casa di Cura Hesperia Hospital, Modena

  36. 36.

    A.O. San Gerardo, Monza

  37. 37.

    A.O. Specialistica dei Colli, Ospedale Monaldi, Napoli

  38. 38.

    Clinica Mediterranea, Napoli

  39. 39.

    A.O.U. Maggiore della Carità, Novara

  40. 40.

    Policlinico Università di Padova, Padova

  41. 41.

    ISMETT, Palermo

  42. 42.

    Villa Maria Eleonora Hospital, Palermo

  43. 43.

    A.O.U. Ospedale Maggiore, Parma

  44. 44.

    A.O. Ospedale R. Silvestrini, Perugia

  45. 45.

    A.O.U. Pisana – Cisanello, Pisa

  46. 46.

    A.O. S. Carlo, Potenza

  47. 47.

    ICLAS – Istituto Clinico di Alta Specialità, Rapallo

  48. 48.

    Villa Maria Cecilia Hospital, Ravenna (Cotignola)

  49. 49.

    A.O. S.Filippo Neri, Roma

  50. 50.

    A.O. S.Camillo Forlanini, Roma

  51. 51.

    Ospedale S.Andrea, Roma

  52. 52.

    Casa di Cura European Hospital, Roma

  53. 53.

    Policlinico Tor Vergata, Roma

  54. 54.

    Policlinico Universitario A. Gemelli – Università Cattolica, Roma

  55. 55.

    Policlinico Umberto I – Università Sapienza, Roma

  56. 56.

    Policlinico Universitario Campus Bio-medico, Roma

  57. 57.

    Ospedale Civile SS. Annunziata, Sassari

  58. 58.

    A.O.U Senese, Ospedale S. Maria alle Scotte, Siena

  59. 59.

    Casa di Cura Villa Verde, Taranto

  60. 60.

    Ospedale Civile G. Mazzini, Teramo

  61. 61.

    A.O. Santa Maria, Terni

  62. 62.

    A.O. Ospedale Mauriziano Umberto I, Torino

  63. 63.

    A.O.U Città della Salute e della Scienza – Molinette, Torino

  64. 64.

    Ospedale Santa Chiara, Trento

  65. 65.

    Ospedale S.Maria dei Battuti Ca’ Foncello, Treviso

  66. 66.

    A.O.U. Ospedali Riuniti, Trieste

  67. 67.

    A.O.U. S.Maria della Misericordia, Udine

  68. 68.

    Ospedale di Circolo e Fondazione Macchi, Varese

  69. 69.

    Ospedale dell’Angelo, Venezia (Mestre)

  70. 70.

    A.O.U. Ospedale Civile Maggiore, Verona

  71. 71.

    Ospedale San Bortolo, Vicenza

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Bignami, E., Belletti, A., Moliterni, P. et al. Clinical practice in perioperative monitoring in adult cardiac surgery: is there a standard of care? Results from an national survey. J Clin Monit Comput 30, 347–365 (2016). https://doi.org/10.1007/s10877-015-9725-4

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  • DOI: https://doi.org/10.1007/s10877-015-9725-4

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