Filmed at the 2019 STS Annual Meeting in San Diego, California, Daniel Engelman of Baystate Medical Center in Springfield, Massachusetts, USA, moderates a discussion on enhanced recovery after surgery (ERAS) for cardiac surgery. Dr Engelman, who is also the President of the ERAS Cardiac Society, is joined by Rakesh Arora of Saint Boniface Hospital in Winnipeg, Manitoba, Canada, Michael Grant of the Johns Hopkins Hospital in Baltimore, Maryland, USA, Kevin Lobdell of Atrium Health in Charlotte, North Carolina, USA, and Louis Perrault of the Montreal Heart Institute in Quebec, Canada. The panel discusses intraoperative opportunities to apply ERAS principles, including anesthesia, sternal closure technique, and chest drainage. Postoperatively, they highlight reducing kidney injury, managing delirium, multimodal pain management to reduce opioid usage, and avoiding deep vein thrombosis. Looking to the future of ERAS, the group notes that the research possibilities are endless. Finally, they emphasize that the ERAS Cardiac Society is inclusive and open to the entire team of professionals who care for cardiac surgery patients.
This is part II of a two-part discussion. View the first part here.
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The ERAS recommendations for chest tube patency do not mention about the use of suction ( most commonly -20cmH2O) applied to the drainage chambers connected to the chest tubes after shifting the patient to ICU. This is the most commonly utilised procedure used to prevent tamponade. It works very well and is used in almost all major cardiac centers.
I would like to ask the authors, why no mention is made of such an important step to maintain chest tube patency.
Instead they have stressed on Active chest tube clearance ( apparently a product) and all the references are about that product in the name of active chest tube clearance.
There are two authors who are on the board of the company making the product.
I feel that mention of the use of suction should be included in the chest tube patency section which is used worldwide and help to prevent cardiac tamponade.
I would appreciate the views of other senior colleagues.
These are guidelines used worldwide and I am disappointed to see the omission of this important step and promotion of a product in the name of active chest tube clearance in all the references cited.