Clinical impact of the publication of S3 guidelines for intensive care in cardiac surgery patients in Germany: results from a postal survey M. Kastrup 1 , M. Carl 1 , C. Spies 1 , M. Sander 1 , A. Markewitz 2 and U. Schirmer 3 1 Campus Virchow-Klinikum and Campus Charité Mitte, Department of Anaesthesiology and Intensive Care, Charité-University Medicine, Berlin, Germany, 2 Department of Cardiovascular Surgery, Central Military Hospital, Koblenz, Germany and 3 Institute of Anaesthesiology, Heart and Diabetes Center NRW, Ruhr University of Bochum, Bad Oeynhausen, Germany Introduction: The development and implementation of prac- tice guidelines might be an important tool to evaluate the differ- ent practices and to consider different local strategies. Methods: A postal questionnaire with 37 questions was sent to the leading physicians of 80 intensive care units in Germany, treating patients after cardiothoracic surgery. The survey covered the same core questions on current practice of hemody- namic monitoring, volume replacement, inotropic/vasopressor support, and transfusions before and after the publication of an S3 guideline. Results: A total of 77.5 % of the completed questionnaires were returned. Monitoring changed to increased use of central venous oxygen saturation (ScvO2) in 55.1% (2005: 20.9%), end-tidal CO2- monitoring 36.2% (2005: 24.3%), and decreased use of the left atrial pressure with 12.3% (2005: 23.3%) and pulmonary artery catheter 47.5% (2005: 58.2%). For volume therapy, there is a decreased use of Hydroxyethyl starch (HES) with 38.7% (2005: 63.4%) and an increased use of crystalloids 41.9% (2005: 22.4%). For inotropes, there is a trend to a decreased use of dopamine with 9.7% (2005: 29.1%, P = 0.074). The clinical relevance of the guidelines was judged ‘high’ by 43.5% and ‘medium’ by 50% of the responding physicians; however, change of treatments was reported by one quarter of respondents. Conclusion: Despite ongoing variability in the use of monitor- ing devices, volume replacement and vasopressor/inotrope use in cardiac surgery patients, there have been some changes in the therapy of these patients after publication of the guidelines. Because the guideline has been considered as clinically relevant, further interdisciplinary development and implementation support should be considered. Accepted for publication 18 September 2012 © 2012 The Authors Acta Anaesthesiologica Scandinavica © 2012 The Acta Anaesthesiologica Scandinavica Foundation H emodynamic monitoring and adequate volume therapy, as well as the treatment with positive inotropic drugs and vasopressors, are the basic principles of the post-operative intensive care treatment of patients after cardiothoracic surgery. In December 2006, the German Society for Thoracic and Cardiovascular Surgery (DGTHG) and the German Society for Anaesthesiology and Intensive Care Medicine (DGAI) published S3 guidelines to give recommendations on therapeutic goals for monitoring and therapy of patients after cardiac sur- gery. 1 The goal of the guideline was to assess avail- able monitoring methods and their risks, as well as the differentiated therapy of volume replacement, positive inotropic support and vasoactive drugs, the therapy with vasodilators, inodilators and calcium- sensitizers, and the use of intra-aortic balloon pumps. The guideline was developed according to the recommendations for the development of guide- lines by the Association of the Scientific Medical Societies in Germany 2 and was consented by DGTHG and DGAI after two consensus meetings. To evaluate the clinical practice in monitoring and treatment of cardiac surgical patients in Germany before the establishment of practice-oriented guide- lines, a survey was performed. 3 As the results of that survey reflected current practice at that time, some of the results were included in the guidelines. About 1 1 / 2 years after the publication of the guidelines, the survey was repeated to document the clinical impact of the guidelines. Another objec- tive was to find out how the guidelines were incor- porated in clinical routine and what improvement is needed in order to achieve a better acceptance. Acta Anaesthesiol Scand 2012; ••: ••–•• Printed in Singapore. All rights reserved © 2012 The Authors Acta Anaesthesiologica Scandinavica © 2012 The Acta Anaesthesiologica Scandinavica Foundation ACTA ANAESTHESIOLOGICA SCANDINAVICA doi: 10.1111/aas.12009 1