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Sep 22

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Findings from a new single-center study examined whether a machine learning algorithm could guide goal-directed fluid therapy in patients recovering from cardiac surgery.Among 479 isolated coronary artery bypass patients with an ejection fraction of 45% or greater, 233 were managed under the goal-directed fluid therapy program and compared with 246 matched historical controls.Acute kidney injury incidence by KDIGO criteria was lower in the goal-directed therapy group at postoperative day 2, at postoperative day 7, and at discharge.The authors describe the program as safe, with less invasive monitoring for selected ICU patients.These findings contribute to ongoing discussions around how advanced analytics may support, rather than replace, clinical judgment in postoperative care.Congratulations to Advanced Practice Provider Council Member Amanda Rea, DNP, CRNP, and Executive Board Member Rawn Salenger, MD, on this important contribution.Read the full study: link in bio#ERASCardiac #CardiacSurgery #CardiacICU #MachineLearning #AKI
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View Instagram post by eras_cardiac

Sep 21

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ERAS Cardiac Recommendation: Central Nervous System MonitoringNeurologic complications remain an important concern after cardiac surgery, and central nervous system monitoring is one way teams look for early indications of neurologic risk.Modalities such as cerebral oximetry and processed electroencephalography (EEG) may provide early warning of neurologic risk or excessive anesthetic depth. Some studies suggest improved neurocognitive outcomes or earlier recognition of cerebral hypoperfusion, but interventions triggered by monitoring are inconsistent across studies. This ERAS Cardiac recommendation is supported by a moderate level of evidence.Central nervous system monitoring may enhance neurologic surveillance, while additional study is necessary to identify the strategies that best prevent and mitigate injury.Read the full recommendation here: link in bio
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Sep 15

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Opioid-sparing pain management after cardiac surgery is widely endorsed. Building an actual order set, with agents, doses, and frequency is a challenge.The ERAS Cardiac Multimodal Analgesia Turnkey Order Set translates existing consensus recommendations into a sample order set ready for immediate bedside application.Developed from ANZCA, ERAS Cardiac, POQI, and SCA recommendations.Access to the ERAS Cardiac Virtual Education Center is free. Create an account to download the full Turnkey Order Set PDF and share it with your team. View the full order set: link in bio#ERASCardiac #MultimodalAnalgesia #OpioidStewardship #CardiacSurgery #EnhancedRecovery
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Sep 10

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I grew up with enhanced recovery at the dinner table. In the early 1990s, my father, Richard Engelman, pioneered the Fast Track approach to recovery after heart surgery, built on a then radical idea: that what happens before and after the operation matters as much as the operation itself. Years later, as I watched those lessons fade from everyday practice, a group of us founded the ERAS Cardiac Society in 2017 to bring them back with modern evidence.When we published the first cardiac enhanced recovery guidelines in JAMA Surgery in 2019, my father was one of my coauthors. Of everything I have written, that byline means the most.What keeps me motivated is the team. Enhanced recovery has never been a surgeon's protocol. It belongs to the whole interdisciplinary family: anesthesiology, critical care, nursing, advanced practice providers, perfusion, pharmacy, physical therapy, nutrition, and above all the patient and their family. Nothing in medicine beats watching that team pull in the same direction so a patient can wake up sooner, hurt less, and get back to their life.And on the days I need a reminder of why we do this, I keep one close at hand. I have saved every letter a grateful patient has ever written me. I still reread them. Behind every guideline, protocol, and acronym is a person who trusted us with their heart. Those letters, and the team that earns them, are the heart of ERAS for me. #HeartofERAS-Daniel Engelman, MD, President, ERAS Cardiac Society
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