Chatterjee Subhasis, Cangut Busra, Rea Amanda, Salenger Rawn, Arora Rakesh C, Grant Michael C, Morton-Bailey Vicki, Hirji Sameer, Engelman Daniel T
Department of Surgery, Baylor College of Medicine and Texas Heart Institute, Houston, Tex.
Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
JTCVS Open. 2024 Feb 19;18:118-122. doi: 10.1016/j.xjon.2024.02.008. eCollection 2024 Apr.
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.
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.
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.
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.
术后房颤（POAF）是心脏手术后常见的并发症，与不良事件增加相关。已发布了多项指南和专家共识文件，涉及POAF的预防和管理。我们旨在制定一套医嘱集，以促进心脏手术后基于证据的POAF诊疗措施的广泛实施和采用。
咨询了主题专家，将现有指南和文献转化为一份针对POAF的示例交钥匙医嘱集（TKO）。源自参考指南和共识手稿中一致的I类或IIA类或同等推荐的医嘱在TKO中以粗体显示。不一致的I类或IIA类、IIB类或有已发表证据支持的选定医嘱以斜体显示。
术前，建议筛查患者是否存在阵发性或慢性房颤，并根据POAF发生的个体风险分层启动适当治疗。这可能包括根据患者的具体风险状况给予β受体阻滞剂或胺碘酮。术中，对于选定患者应考虑进行如心包后切开术等手术干预。术后，关键是要关注电解质正常化、心率或心律控制的实施策略以及抗凝管理。这些综合措施旨在优化患者预后并减少心脏手术后POAF的发生。
尽管在心脏手术中实施多学科POAF护理路径有明确益处，但其采用和实施仍不一致。我们制定了一个易于应用的医嘱集，纳入了现有指南的建议。
