Réhabilitation améliorée après chirurgie cardiaque adulte sous CEC ou à cœur battant 2021

Mertès, Paul-Michel; Kindo, Michel; Amour, Julien; Baufreton, Christophe; Camilleri, Lionel; Caus, Thierry; Chatel, Didier; Cholley, Bernard; Curtil, Alain; Grimaud, Jean-Philippe; Houel, Rémi; Kattou, Fehmi; Guidon, C.; Guinot, Pierre Grégoire; Lebreton, Guillaume; Marguerite, Sandrine; Ouattara, Alexandre; Fruithiot, Sophie Provenchère; Rozec, Bertrand; Verhove, Jean-Philippe; Vincentelli, André; Charbonneau, Hélène

doi:10.1016/j.anrea.2022.10.008

Cited by 4 publications

(2 citation statements)

References 270 publications

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“…Notably, our study focused on modern cardiac care, where physicians employ proactive hemodynamic strategies and optimize cardiovascular states (Patel et al, 2020), potentially mitigating perioperative risks associated with ACE inhibitor maintenance. These strategies are part of enhanced recovery after surgery (ERAS) programs and are widely recommended (Mertes et al, 2022). These results, therefore, corroborate a previous pilot randomized controlled trial conducted by van Diepen et al (2018).…”

Section: Discussionsupporting

confidence: 82%

Pre-operative maintenance of angiotensin-converting enzyme inhibitors is not associated with acute kidney injury in cardiac surgery patients with cardio-pulmonary bypass: a propensity-matched multicentric analysis

Guilleminot,

Andrei,

Nguyen

et al. 2024

Front. Pharmacol.

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Objective: We investigated the effects of the maintenance of angiotensin-converting enzyme inhibitors (ACE inhibitors) the day of the surgery on the incidence of postoperative acute kidney injury (AKI) and cardiac events in patients undergoing cardiac surgery.Methods: We performed a multicentric observational study with propensity matching on 1,072 patients treated with ACE inhibitors. We collected their baseline demographic data, comorbidities, and operative and postoperative outcomes. AKI was defined by KDIGO (Kidney Disease: Improving Global Outcome).Results: Maintenance of an ACE inhibitor was not associated with an increased risk of AKI (OR: 1.215 (CI95%:0.657–2.24), p = 0.843, 71 patients (25.1%) vs. 68 patients (24%)). Multivariate logistic regression and sensitive analysis did not demonstrate any association between ACE inhibitor maintenance and AKI, following cardiac surgery (OR: 1.03 (CI95%:0.81–1.3)). No statistically significant difference occurs in terms of incidence of cardiogenic shock (OR: 1.315 (CI95%:0.620–2.786)), stroke (OR: 3.313 (CI95%:0.356–27.523)), vasoplegia (OR: 0.741 (CI95%:0.419–1.319)), postoperative atrial fibrillation (OR: 1.710 (CI95%:0.936–3.122)), or mortality (OR: 2.989 (CI95%:0.343–26.034)). ICU and hospital length of stays did not differ (3 [2; 5] vs. 3 [2; 5] days, p = 0.963 and 9.5 [8; 12] vs. 10 [8; 14] days, p = 0.638).Conclusion: Our study revealed that maintenance of ACE inhibitors on the day of the surgery was not associated with increased postoperative AKI. ACE inhibitor maintenance was also not associated with an increased rate of postoperative major cardiovascular events (arterial hypotension, cardiogenic shock, vasopressors use, stroke and death).

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Section: Discussionsupporting

confidence: 82%

Pre-operative maintenance of angiotensin-converting enzyme inhibitors is not associated with acute kidney injury in cardiac surgery patients with cardio-pulmonary bypass: a propensity-matched multicentric analysis

Guilleminot,

Andrei,

Nguyen

et al. 2024

Front. Pharmacol.

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“…The ERAS Cardiac Society emerged in 2017, culminating in the publication of specific guidelines in 2019 [ 5 ] in collaboration with the ERAS Society International. Further developments occurred in 2022 when the French Society of Anaesthesia and Intensive Care Medicine, in collaboration with the French Society of Thoracic and Cardiovascular Surgery, released their Guidelines on Enhanced Recovery After Cardiac Surgery [ 6 ]. This marked a paradigm shift from traditional, localized care practices to a more structured, integrated approach to patient care.…”

Section: Introductionmentioning

confidence: 99%

Implementation of cardiac enhanced recovery after surgery at Lausanne University Hospital, our roadbook to certification

Ltaief,

Verdugo-Marchese,

Carel

et al. 2024

Interdisciplinary CardioVascular and Thoracic Surgery

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OBJECTIVES Enhanced recovery after surgery (ERAS) is a multidisciplinary, patient-centred approach aimed at expediting recovery, improving clinical outcomes, and reducing healthcare costs. Initially developed for colorectal surgery, ERAS principles have been successfully applied across various surgical specialties, including cardiac surgery. This study outlines the implementation and certification process of the ERAS program in a tertiary cardiac surgical centre within the Heart-Vessel Department at Lausanne University Hospital. METHODS The implementation involved forming a multidisciplinary team, including cardiac surgeons, anaesthesiologists, intensivists, a cardiologist, clinical nurse specialists and physiotherapists. The ERAS nurse coordinator played a central role in organizing meetings, promoting the program, developing protocols, and collecting data. The certification process required adherence to ERAS guidelines, structured training and external evaluation. Key phases included pre-ERAS data collection, protocol dissemination, inclusion of the 1st patients, followed by analysis and full implementation. RESULTS Achieving certification required maintaining a compliance rate of over 70% with established protocols. The process involved overcoming various barriers, such as inconsistent practices and the need for multidisciplinary collaboration. In this paper, we provide some solutions to these challenges, including team education, regular meetings and continuous feedback loops. Preliminary data from the initial cohort showed improvements in early mobilization, opioid use, respiratory complications and shorter hospital stays. CONCLUSIONS The successful implementation of the ERAS program at our institution demonstrates the feasibility and benefits of a structured, multidisciplinary approach in cardiac surgery. Continuous self-assessment and adherence to guidelines are essential for sustained improvement in patient outcomes and healthcare efficiency.

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Effect of Active Physiotherapy With Positive Airway Pressure on Pulmonary Atelectasis After Cardiac Surgery: A Randomized Controlled Study

Baneton,

Dauvergne,

Gouillet

et al. 2023

Journal of Cardiothoracic and Vascular Anesthesia

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Réhabilitation améliorée après chirurgie cardiaque adulte sous CEC ou à cœur battant 2021

Cited by 4 publications

References 270 publications

Pre-operative maintenance of angiotensin-converting enzyme inhibitors is not associated with acute kidney injury in cardiac surgery patients with cardio-pulmonary bypass: a propensity-matched multicentric analysis

Pre-operative maintenance of angiotensin-converting enzyme inhibitors is not associated with acute kidney injury in cardiac surgery patients with cardio-pulmonary bypass: a propensity-matched multicentric analysis

Implementation of cardiac enhanced recovery after surgery at Lausanne University Hospital, our roadbook to certification

Effect of Active Physiotherapy With Positive Airway Pressure on Pulmonary Atelectasis After Cardiac Surgery: A Randomized Controlled Study

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