2022: Perioperative and critical care year in review for the cardiothoracic surgery team

Abstract

This year, we have again assembled an expert opinion on several key topics that pertain to the perioperative and critical care management of patients undergoing cardiac surgery and for patients requiring extracorporeal membrane oxygenation. Approximately 1 in 3 patients undergoing cardiac surgery have diabetes mellitus; contemporary glycemic control management of these patients to minimize perioperative complications are reviewed. Goal-directed fluid therapy remains an area on interest and controversy; the use of albumin as a resuscitation fluid and recent clinical trial data are reviewed. Delirium is characterized as an acute confusion state occurring in 20% to 25% of patients after cardiac surgery. Insights on integrating the whole interdisciplinary team, including the family, with the Delirium Team Approach program are discussed. Optimal management for refractory hypoxemia with venovenous extracorporeal membrane oxygenation and the role of prone positioning remain a question. Data supporting this technique during venovenous extracorporeal membrane oxygenation is reviewed—lastly, the contemporary management and supporting evidence for refractory postoperative vasoplegic shock after cardiopulmonary bypass is provided.