PERIOPERATIVE CRITICAL CARE IN CARDIOTHORACIC SURGERY: A REVIEW OF RECENT ADVANCES
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Keywords
Cardiothoracic surgery; Perioperative critical care; Acute kidney injury; Enhanced recovery after surgery; Artificial intelligence
Abstract
Cardiothoracic surgery is associated with significant perioperative physiological stress and a high risk of postoperative complications, including hemodynamic instability, organ dysfunction, infection, and neurological impairment. Advances in perioperative critical care have contributed substantially to improved survival and recovery, making ICU-based management an essential component of modern cardiothoracic practice. This review aims to summarize recent advances in perioperative critical care strategies for cardiothoracic surgery patients, focusing on optimized hemodynamic management, prevention of major postoperative organ dysfunction, enhanced recovery pathways, and emerging innovations shaping future practice. A narrative synthesis of contemporary literature was undertaken, emphasizing guideline updates, randomized trials, systematic reviews, and recent innovations in perioperative cardiothoracic critical care. Key domains included preoperative risk stratification, cardiopulmonary bypass management, postoperative organ protection, and supportive ICU interventions. Recent progress in perioperative care includes improved preoperative optimization through frailty assessment and anemia management, alongside innovations in cardiopulmonary bypass and goal-directed perfusion therapy. Postoperative complications such as acute kidney injury and respiratory failure remain major challenges, but biomarker-guided KDIGO bundles and protective ventilation strategies have strengthened prevention and management. Enhanced Recovery After Surgery (ERAS) protocols integrating multimodal analgesia, early mobilization, and nutritional support have demonstrated reductions in ICU stay and morbidity. Neurological complications, particularly delirium and cognitive dysfunction, highlight the importance of sedation optimization and cerebral perfusion maintenance. Emerging technologies such as point-of-care ultrasound, artificial intelligence, and digital ICU monitoring systems offer promising avenues for precision-based perioperative management. Perioperative critical care in cardiothoracic surgery is rapidly evolving, driven by multidisciplinary protocols, technological innovation, and evidence-based organ protection strategies.
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Dr .C.Devadoss
Assistant professor, Arunai Medical College, Thiruvannamalai, Tamil Nadu Mgr Medical University, [email protected]
