Subhasis Chatterjee MD , Busra Cangut MD , Amanda Rea DNP, CRNP, AGACNP-BC, CCRN, CMC, CSC, E-AEC , Rawn Salenger MD , Rakesh C. Arora MD , Michael C. Grant MD , Vicki Morton-Bailey DNP, MSN, AGNP-BC , Sameer Hirji MD, MPH , Daniel T. Engelman MD
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引用次数: 0
摘要
背景术后心房颤动(POAF)是心脏手术后的一种常见并发症,与不良事件的增加有关。目前已发布了多份指南和专家共识文件,旨在预防和处理 POAF。我们的目标是制定一套医嘱,以促进心脏手术后 POAF 循证实践的广泛实施和采用。方法咨询相关专家,将现有指南和文献转化为 POAF 的整套医嘱样本 (TKO)。根据参考指南和共识手稿中一致的 I 级或 IIA 级或同等建议制定的医嘱以粗体字显示在 TKO 中。结果术前,建议筛查阵发性或慢性心房颤动患者,并根据发生 POAF 的个体风险分层启动适当的治疗。这可能包括根据患者的具体风险情况使用β-受体阻滞剂或胺碘酮。术中,应考虑对特定患者进行手术干预,如后心包切开术。术后重点关注电解质正常化、实施心率或心律控制策略以及抗凝管理,这一点至关重要。这些综合措施旨在优化患者预后,减少心脏手术后 POAF 的发生。结论尽管针对心脏手术后 POAF 实施多学科护理路径的益处已得到充分证实,但其采用和实施情况仍不一致。我们开发了一套易于应用的指令集,其中包含了现有指南中的建议。
Enhanced Recovery After Surgery Cardiac Society turnkey order set for prevention and management of postoperative atrial fibrillation after cardiac surgery: Proceedings from the American Association for Thoracic Surgery ERAS Conclave 2023
Background
Postoperative atrial fibrillation (POAF) is a prevalent complication following cardiac surgery that is associated with increased adverse events. Several guidelines and expert consensus documents have been published addressing the prevention and management of POAF. We aimed to develop an order set to facilitate widespread implementation and adoption of evidence-based practices for POAF following cardiac surgery.
Methods
Subject matter experts were consulted to translate existing guidelines and literature into a sample turnkey order set (TKO) for POAF. Orders derived from consistent class I or IIA or equivalent recommendations across referenced guidelines and consensus manuscripts appear in the TKO in bold type. Selected orders that were inconsistently class I or IIA, class IIB, or supported by published evidence appear in italic type.
Results
Preoperatively, the recommendation is to screen patients for paroxysmal or chronic atrial fibrillation and initiate appropriate treatment based on individual risk stratification for the development of POAF. This may include the administration of beta-blockers or amiodarone, tailored to the patient's specific risk profile. Intraoperatively, surgical interventions such as posterior pericardiotomy should be considered in selected patients. Postoperatively, it is crucial to focus on electrolyte normalization, implementation strategies for rate or rhythm control, and anticoagulation management. These comprehensive measures aim to optimize patient outcomes and reduce the occurrence of POAF following cardiac surgery.
Conclusions
Despite the well-established benefits of implementing a multidisciplinary care pathway for POAF in cardiac surgery, its adoption and implementation remain inconsistent. We have developed a readily applicable order set that incorporates recommendations from existing guidelines.