Department of Anaesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, FMTS de Strasbourg, Strasbourg, France.
Department of Cardiac Surgery, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, FMTS de Strasbourg, Strasbourg, France.
Anaesth Crit Care Pain Med. 2022 Jun;41(3):101059. doi: 10.1016/j.accpm.2022.101059. Epub 2022 Apr 30.
To provide recommendations for enhanced recovery after cardiac surgery (ERACS) based on a multimodal perioperative medicine approach in adult cardiac surgery patients with the aim of improving patient satisfaction, reducing postoperative mortality and morbidity, and reducing the length of hospital stay.
A consensus committee of 20 experts from the French Society of Anaesthesia and Intensive Care Medicine (Société française d'anesthésie et de réanimation, SFAR) and the French Society of Thoracic and Cardiovascular Surgery (Société française de chirurgie thoracique et cardio-vasculaire, SFCTCV) was convened. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. The entire guideline process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide the assessment of the quality of evidence.
Six fields were defined: (1) selection of the patient pathway and its information; (2) preoperative management and rehabilitation; (3) anaesthesia and analgesia for cardiac surgery; (4) surgical strategy for cardiac surgery and bypass management; (5) patient blood management; and (6) postoperative enhanced recovery. For each field, the objective of the recommendations was to answer questions formulated according to the PICO model (Population, Intervention, Comparison, Outcome). Based on these questions, an extensive bibliographic search was carried out and analyses were performed using the GRADE approach. The recommendations were formulated according to the GRADE methodology and then voted on by all the experts according to the GRADE grid method.
The SFAR/SFCTCV guideline panel provided 33 recommendations on the management of patients undergoing cardiac surgery under cardiopulmonary bypass or off-pump. After three rounds of voting and several amendments, a strong agreement was reached for the 33 recommendations. Of these recommendations, 10 have a high level of evidence (7 GRADE 1+ and 3 GRADE 1-); 19 have a moderate level of evidence (15 GRADE 2+ and 4 GRADE 2-); and 4 are expert opinions. Finally, no recommendations were provided for 3 questions.
Strong agreement existed among the experts to provide recommendations to optimise the complete perioperative management of patients undergoing cardiac surgery.
基于多模式围手术期医学方法，为成人心脏手术患者提供心脏手术后加速康复（ERACS）的建议，旨在提高患者满意度，降低术后死亡率和发病率，并缩短住院时间。
法国麻醉与重症监护学会（Société française d'anesthésie et de réanimation，SFAR）和法国心胸血管外科学会（Société française de chirurgie thoracique et cardio-vasculaire，SFCTCV）的 20 名专家组成共识委员会。在整个过程开始时制定了一项正式的利益冲突政策，并严格执行。整个指南制定过程独立于任何行业资助。作者被建议遵循推荐评估、制定和评估（GRADE）系统的原则，以指导证据质量的评估。
定义了六个领域：（1）患者路径的选择及其信息；（2）术前管理和康复；（3）心脏手术的麻醉和镇痛；（4）心脏手术的外科策略和旁路管理；（5）患者血液管理；（6）术后加速康复。对于每个领域，建议的目的是根据 PICO 模型（人群、干预、比较、结果）回答问题。基于这些问题，进行了广泛的文献检索，并使用 GRADE 方法进行了分析。建议根据 GRADE 方法制定，然后由所有专家根据 GRADE 网格方法进行投票。
SFAR/SFCTCV 指南小组就体外循环或非体外循环下心内直视手术患者的管理提供了 33 项建议。经过三轮投票和几次修订，33 项建议达成强烈一致。其中 10 项具有高证据水平（7 项 GRADE 1+和 3 项 GRADE 1-）；19 项具有中证据水平（15 项 GRADE 2+和 4 项 GRADE 2-）；4 项为专家意见。最后，对 3 个问题没有提出建议。
专家们对提供建议以优化接受心脏手术患者围手术期的综合管理达成了强烈共识。
