Innovative approaches in the perioperative care of the cardiac surgical patient in the operating room and intensive care unit.

Denault, André; Lamarche, Yoan; Rochon, Antoine; Cogan, Jennifer; Liszkowski, Mark; Lebon, Jean-Sébastien; Ayoub, Christian; Taillefer, Jean; Blain, Robert; Viens, Claudia; Couture, Pierre; Deschamps, Alain

Perioperative care for cardiac surgery is undergoing rapid evolution. Many of the changes involve the application of novel technologies to tackle common challenges in optimizing perioperative management. Herein, we illustrate recent advances in perioperative management by focusing on a number of novel components that we judge to be particularly important. These include: the introduction of brain and somatic oximetry; transesophageal echocardiographic hemodynamic monitoring and bedside focused ultrasound; ultrasound-guided vascular access; point-of-care coagulation surveillance; right ventricular pressure monitoring; novel inhaled treatment for right ventricular failure; new approaches for postoperative pain management; novel approaches in specialized care procedures to ensure quality control; and specific approaches to optimize the management for postoperative cardiac arrest. Herein, we discuss the reasons that each of these components are particularly important in improving perioperative care, describe how they can be addressed, and their impact in the care of patients who undergo cardiac surgery.