Perioperative Care in Cardiac Surgery

Tranexamic acid or epsilon aminocaproic acid during on-pump cardiac surgical procedures

Perioperative glycemic control

A care bundle of evidence-based best practices to reduce surgical site infections

Goal-directed fluid therapy

A perioperative, multimodal, opioid-sparing, pain management plan

Avoidance of persistent hypothermia (<36.0°C) after cardiopulmonary bypass in the early postoperative period

Maintenance of chest tube patency to prevent retained blood

Postoperative systematic delirium screening tool use at least once per nursing shift

Stopping smoking and hazardous alcohol consumption 4 weeks before elective surgery

Early detection of kidney stress and interventions to avoid acute kidney injury after surgery

Use of rigid sternal fixation to potentially improve or accelerate sternal healing and reduce mediastinal wound complications

Prehabilitation for patients undergoing elective surgery with multiple comorbidities or significant deconditioning

An insulin infusion to treat hyperglycemia in all patients postoperatively

Strategies to ensure extubation within 6 h of surgery

Patient engagement tools, including online/applicationbased systems to promote education, compliance, and patient-reported outcomes

Chemical or mechanical thromboprophylaxis after surgery

Preoperative measurement of hemoglobin A1c to assist with risk stratification

Preoperative correction of nutritional deficiency when feasible

Continued consumption of clear liquids up until 2 to 4 h before general anesthesia

Preoperative oral carbohydrate loading may be considered before surgery

Stripping or breaking the sterile field of chest tubes to remove clots

Hyperthermia (>37.9°C) while rewarming on cardiopulmonary bypass.