ENHANCED RECOVERY AFTER CARDIAC SURGERY PROTOCOL

Yıl 2021, , 157 - 170, 27.08.2021

Selda Mert Boğa , Aylin Aydın Sayılan

https://doi.org/10.53490/egehemsire.651868

Öz

KALP CERRAHİSİ SONRASI HIZLANDIRILMIŞ İYİLEŞME PROTOKOLÜ

Öz

Son yıllarda ortaya çıkan gelişmeler, sağlık bakım hizmetini doğrudan etkilemektedir. Cerrahi Sonrası Hızlandırılmış İyileşme Protokolü, cerrahi bakım kalitesini yükseltmeyi hedefleyen, ameliyat öncesi ve sonrası iyileşmeyi kapsayan bir süreç olup, sağlık bakım hizmetlerinde çok önemli bir rol üstlenmiştir. Kalp cerrahisine yönelik hızlandırılmış iyileşme protokolü ise oldukça yeni uygulanmaya başlanmıştır. Kalp cerrahisine özgü geliştirilen kanıta dayalı cerrahi dönem bakım rehberi, klinik sonuçlarda iyileşme ve maliyette azalma olarak olumlu etkisini göstermekte; kalp cerrahisi uygulanan hastaların iyileşmesinde standart bir bakımı hedeflemektedir. Bu derlemenin içeriğinde; ameliyat öncesi dönem izlemleri (hemoglobin A1 ölçümü, albumin ölçümü, beslenme yetersizliğinin düzeltilmesi, anestezi öncesi berrak sıvı tüketimi, karbonhidrat yüklemesi, hasta tarafından iletilen sorunlara yönelik eğitim, uygulamalar, prehabilitasyon, sigara ve alkol tüketimi), ameliyat sırası izlem (cerrahi alan enfeksiyonunu azaltma, hipertermi, sert sternal fiksasyon, traneksamik asit veya epsilon aminokaproik asit) ve ameliyat sonrası izlem (glisemik kontrol, insülin infüzyonu, ağrı yönetimi, sistematik deliryum taraması, inatçı hipotermi, göğüs tüpü açıklığı, tromboprofilaksi, ekstübasyon, böbrek stresi ve akut böbrek hasarı, hedefe yönelik sıvı tedavisi) ve diğer cerrahi sonrası hızlandırılmış iyileşme önerileri yer almaktadır. Elde edilen veriler derecelendirilerek, önerilerde bulunulmaktadır. Bu öneriler Cerrahi Sonrası Hızlandırılmış İyileşme Derneği tarafından onaylanmıştır. Bu derlemede, Engelman ve ark. (2019) tarafından kalp cerrahisine özgü oluşturulan hızlandırılmış iyileşme protokolü önerilerinden söz edilmektedir.

Anahtar Kelimeler

Cerrahi Sonrası Hızlandırılmış İyileşme, kalp cerrahisi, hemşire

Kaynakça

• Allen, K.B., Thourani, V.H., Naka, Y., Grubb, K.J., Grehan, J., Patel, N. … Cohen, D.J. (2017). Randomized, multicenter trial comparing sternotomy closure with rigid plate fixation to wire cerclage. J Thorac Cardiovasc Surg, 153(4), 888-896. doi: 10.1016/j.jtcvs.2016.10.093
• Apfel, C.C., Turan, A., Souza, K., Pergolizzi, J., Hornuss, C. (2013). Intravenous acetaminophen reduces postoperative nausea and vomiting: A systematic review and meta-analysis. Pain, 154(5), 677-689. doi: 10.1016/j.pain.2012.12.025
• Bode, L.G., Kluytmans, J.A., Wertheim, H.F., Bogaers, D., Vandenbroucke-Grauls, C.M., Roosendaal, R. … Vos, M.C. (2010). Preventing surgical-site ınfections in nasal carriers of staphylococcus aureus. N Engl J Med, 362(1), 9-17. doi: 10.1056/NEJMoa0808939
• Boyle, E.M Jr., Gillinov, A.M., Cohn, W.E., Ley, S.J., Fischlein, T., Perrault, L.P. (2015). Retained blood syndrome after cardiac surgery: A new look at an old problem. Innovations (Phila), 10(5), 296-03. doi: 10.1097/imi.0000000000000200
• Cook, D.J., Manning, D.M., Holland, D.E., Prinsen, S.K., Rudzik, S.D., Roger, V.L. … Deschamps, C. (2013). Patient engagement and reported outcomes in surgical recovery: effectiveness of an e-health platform. J AmColl Surg, 217(4), 648-655. doi: 10.1016/j.jamcollsurg.2013.05.003
• Engelman, R., Shahian, D., Shemin, R., Guy, T.S., Bratzler, D., Edwards, F. … Bridges, C. (2007). Workforce on Evidence-Based Medicine, Society of Thoracic Surgeons. The society of thoracic surgeons practice guideline series: antibiotic prophylaxis in cardiac surgery, Part II: Antibiotic Choice. Ann Thorac Surg, 83(4), 1569-76. doi: 10.1016/j.athoracsur.2006.09.046
• Engelman, D.T., Ben Ali, W., Williams, J.B., Perrault, M.D., Reddy, V.S., Arora, R.C. … Boyle, E.M. (2019). Guidelines for perioperative care in cardiac surgery: Enhanced Recovery After Surgery Society recommendations. JAMA Surg, doi: 10.1001/jamasurg.2019.1153.
• Feguri, G.R., de Lima, P.R.L., de Cerqueira Borges, D., Toledo, L.R., Batista, L.N., e Silva, T.C. … Aguilar Nascimento, J.E. (2017). Preoperative carbohydrate load and intraoperatively ınfused omega-3 polyunsaturated fatty acids positively ımpact nosocomial morbidity after coronary artery bypass grafting: A double-blind controlled randomized trial. Nutr J, 16(1), 24.
• Flynn, B.C., He, J., Richey, M., Wirtz, K., Daon, E. (2019). Early extubation without increased adverse events in high-risk cardiac surgical patients. Ann Thorac Surg, 107(2), 453-59.
• Gandhi, G.Y., Nuttall, G.A., Abel, M.D., Mullany, C.J., Schaff, H.V., O’Brien, P.C. … McMahon, M.M. (2007). Intensive ıntraoperative ınsulin therapy versus conventional glucose management during cardiac surgery: A randomized trial. Ann Intern Med, 146(4), 233-43.
• Grieshaber, P., Heim, N., Herzberg, M., Niemann, B., Roth, P., Boening, A. (2018). Active chest tube clearance after cardiac surgery is associated with reduced reexploration rates. Ann Thorac Surg, 105(6), 1771-77.
• Grocott, H.P., Mackensen, G.B., Grigore, A.M., Mathew, J., Reves, J.G., Phillips- Bute, B. … Newman, M.F. (2002). Neurologic Outcome Research Group (NORG); Cardiothoracic Anesthesiology Research Endeavors (CARE) Investigators’ of the Duke Heart Center. Postoperative hyperthermia is associated with cognitive dysfunction after coronary artery bypass graft surgery. Stroke, 33(2), 537-41.
• Ho, K.M., Bham, E., Pavey, W. (2015). Incidence of venous thromboembolism and benefits and risks of thromboprophylaxis after cardiac surgery: A systematic review and meta-analysis. J AmHeart Assoc, 4(10), e002652.
• Hübner, M., Addor, V., Slieker, J., Griesser, A.C., Lécureux, E. … Demartines, N. (2015). The impact of an enhanced recovery pathway on nursing workload: A retrospective cohort study. Int J Surg, 24(Pt A): 45-50.
• Jacobs, A.K., Anderson, J.L., Halperin, J.L. (2014). The Evolution and future of ACC/AHA clinical practice guidelines: A 30-Year Journey: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol, 64(13), 1373-84.
• Jiménez, R.S., Álvarez, A.B., López, J.T., Jiménez, A.S., Conde, F.G., Carmona Sáez, J.A. (2014). ERAS (Enhanced Recovery after Surgery) in colorectal surgery. In: Khan J.S Chapter, eds. Colorectal Cancer - Surgery, Diagnostics and Treatment. doi: 10.5772/57136.
• Karalapillai, D., Story, D., Hart, G.K., Bailey, M., Pilcher, D., Cooper, D.J. … Bellomo, R. (2011). Postoperative hypothermia and patient outcomes after elective cardiac surgery. Anaesthesia, 66(9), 780-84.
• Karas, P.L., Goh, S.L., Dhital, K. (2015). Is Low Serum Albümin Associated With Postoperative Complications in Patients Undergoing Cardiac Surgery? Interact Cardiovasc Thorac Surg, 21(6), 777-86.
• Karen, M.B., Deborah, S.K., Conor, P.D. (2015). Successful Implementation of an enhanced recovery pathway: The nurse’s role. AORN J, 102, 470-78.
• Lannemyr, L., Bragadottir, G., Hjärpe, A., Redfors, B., Ricksten, S.E. (2019). Impact of cardiopulmonary bypass flow on renal oxygenation in patients undergoing cardiac operations. Ann Thorac Surg, 107(2), 505-11.
• Lazar, H.L., Salm, T.V., Engelman, R., Orgill, D., Gordon, S. (2016). Prevention And management of sternal wound infections. J Thorac Cardiovasc Surg, 152(4), 962-72.
• Li, M., Zhang, J., Gan, T.J., Qin, G., Wang, L., Zhu, M. … Wang, E. (2018). Enhanced recovery after surgery pathway for patients undergoing cardiac surgery: a randomized clinical trial. Eur J Cardiothorac Surg, 54(3), 1-7.
• Ljungqvist, O., Scott, M.D., Fearon, K.C. (2017). Enhanced recovery after surgery a review. JAMA Surg. 152(3), 292-98.
• Macisaac, R.J., Jerums, G. (2011). Intensive glucose control and cardiovascular outcomes in type 2 diabetes. Heart Lung Circ, 20(10), 647-654.
• Maldonado, J.R. (2013). Neuropathogenesis of delirium: Review of current etiologic theories and common pathways. Am J Geriatr Psychiatry, 21(12), 1190-1122.
• Meersch, M., Schmidt, C., Hoffmeier, A., Van Aken, H., Wempe, C., Gerss, J. … Zarbock, A. (2017). Prevention of cardiac surgery-associated AKI by İmplementing the KDIGO guidelines in high risk patients identified by biomarkers: The prevaki randomized controlled trial. Intensive Care Med, 43(11), 1551-1561.
• Mert Boğa, S. (2018). The Enhanced Recovery After Surgery Protocol and The Role Of Surgical Nurses. Advances In Health And Natural Sciences (Eds. B. Yüksel, M.S. Karagül). p. 65-82. Copyright © 2018by Nova Science Publishers, Inc.
• Myles, P.S., Smith, J.A., Forbes, A., Silbert, B., Jayarajah, M., Painter, T. … Wallace, S. (2017). ATACAS Investigators of the ANZCA Clinical Trials Network. Tranexamic acid in patients undergoing coronary-artery surgery. N Engl J Med, 376(2), 136-148.
• Narayan, P., Kshirsagar, S.N., Mandal, C.K., Ghorai, P.A., Rao, Y.M., Das, D. … Das M. (2017). Preoperative glycosylated hemoglobin: A risk factor for patients undergoing coronary artery bypass. Ann Thorac Surg, 104(2), 606-612.
• Orange, S.T., Northgraves, M.J., Marshall, P., Madden, L.A., Vince, R.V. (2018). Exercise prehabilitation in elective ıntra-cavity surgery: A role within the ERAS pathway? A narrative review. Int J Surg, 56, 328-333.
• Osawa, E.A., Rhodes, A., Landoni, G., Galas, F.R., Fukushima, J.T., Park, C.H. … Hajjar LA. (2016). Effect of perioperative goal-directed hemodynamic resuscitation therapy on outcomes following cardiac surgery: a randomized clinical trial and systematic review. Crit Care Med, 44(4), 724-733.
• Task Force on Patient Blood Management for Adult Cardiac Surgery of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Association of Cardiothoracic Anaesthesiology (EACTA), Boer, C., Meesters, M.I., Milojevic, M., Benedetto, U., Bolliger, D., von Heymann, C. … Pagano, D. (2018). 2017 EACTS/EACTA guidelines on patient blood management for adult cardiac surgery. Eur J Cardiothorac Surg, 53(1), 79-111.
• Paling, F.P., Olsen, K., Ohneberg, K., Wolkewitz, M., Fowler, V.G. Jr., DiNubile, M.J. … Kluytmans, J.A.J.W. (2018). Risk prediction for staphylococcus aureus surgical site infection following cardiothoracic surgery: A secondary analysis of the V710-P003 Trial. PLoS One, 13(3), e0193445.
• Park, J.S., Kuo, J.H., Young, J.N., Wong, M.S. (2017). Rigid sternal fixation versus modified wire technique for poststernotomy closures: a retrospective cost analysis. Ann Plast Surg,78(5), 537-542.
• Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration. Anesthesiology, (2017). 126(3), 376-393.
• Rijkenberg, S., Stilma,W., Bosman, R.J., van der Meer, N.J., van der Voort, P.H.J. (2017). Pain measurement in mechanically ventilated patients after cardiac surgery: Comparison of the Behavioral Pain Scale (BPS) and the Critical-Care Pain Observation Tool (CPOT). J Cardiothorac Vasc Anesth, 31(4), 1227- 1234.
• Robich, M.P., Iribarne, A., Leavitt, B.J., Malenka, D.J., Quinn, R.D., Olmstead, E.M. … DiScipio, A.W. Northern New England Cardiovascular Disease Study Group. (2019). Northern New England Cardiovascular Disease Study Group. Intensity of glycemic control affects long-term survival after coronary artery bypass graft surgery. Ann Thorac Surg, 107(2), 477-484.
• Sachdeva, A., Dalton, M., Lees, T. (2018). Graduated compression stockings for prevention of deep vein thrombosis. Cochrane Database Syst Rev, 11, CD001484.
• Stammers, A.N., Kehler, D.S., Afilalo, J., Avery, L.J., Bagshaw, S.M., Grocott, H.P. … Arora, RC. (2015). Protocol for the PREHAB study-pre-operative rehabilitation for reduction of hospitalization after coronary bypass and valvular surgery: A randomised controlled trial. BMJ Open, 5(3), e007250.
• Tengborn, L., Blomback, M., Berntorp, E. (2015).Tranexamic acid-an old drug still going strong and making a revival. Thromb Res, 135(2), 231-242.
• Thiele, R.H., Rea, K.M., Turrentine, F.E., Friel, C.M., Hassinger, T.E., McMurry, T.L. … Hedrick, T.L. (2015). Standardization of care: Impact of an enhanced recovery protocol on length of stay, complications, and direct costs after colorectal surgery. J Am Coll Surg, 220(4), 430-443.
• Trent, M.J., Grimm, J.C., Dungan, S.P., Shah, A.S., Crow, J.R., Shoulders, B.R. … Barodka, V. (2015). Continuous intraoperative cefazolin infusion may reduce surgical site infections during cardiac surgical procedures: a propensity-matched analysis. J Cardiothorac Vasc Anesth, 29(6), 1582-1587.
• Varadhan, K.K., Lobo, D.N., Ljungqvist, O. (2010). Enhanced recovery after surgery: the future of improving surgical care. Crit Care Clin, 26(3), 527-547.
• Watson, D.J. (2017). The role of the nurse coordinator in the enhanced recovery after surgery program. Nursing, 47(9), 13-17.
• Wick, E.C., Grant, M.C., Wu, C.L. (2017). Postoperative multimodal analgesia pain management with nonopioid analgesics and techniques: A review. JAMA Surg, 152(7), 691-697.
• Williams, J.B., McConnell, G., Allender, J.E., Woltz, P., Kane, K., Smith, P.K. … Bradford, W.T. (2018). One-year results from the first us-based Enhanced Recovery After Cardiac Surgery (ERAS cardiac) Program. J Thorac Cardiovasc Surg, pii:S0022-5223(18)33225-2.
• Wong, J., Zoungas, S., Wright, C., Teede, H. (2010). Evidence-based guidelines for perioperative management of diabetes in cardiac and vascular surgery. World J Surg, 34(3), 500-513.
• Yang, L., Kaye, A.D., Venakatesh, A.G., Green, M.S., Asgarian, C.D., Luedi, M.M. … Liu, H. (2017). Enhanced Recovery after Cardiac Surgery: An Update on Clinical Implications. Int Anesthesiol Clin, 55(4), 148-162.
• Yavuz Karamanoğlu, A., Gök, F., Demir Korkmaz, F. (2015). Kalp cerrahisi hastalarında deliryum ve hemşirelik bakımı. Ege Üniversitesi Hemşirelik Fakültesi Dergisi, 31(2), 113-129.
• Yu, P.J., Cassiere, H.A., Dellis, S.L., Manetta, F., Kohn, N., Hartman, A.R. (2015). Impact of preoperative prealbumin on outcomes after cardiac surgery. JPEN J Parenter Enteral Nutr, 39(7), 870-874.