Abstract：
This year, we have again assembled an expert opinion on several key topics that pertain to the perioperative and critical care management of the cardiac surgery patient and for patients requiring extracorporeal membrane oxygenation. Approximately 1 in 3 patients undergoing cardiac surgery have diabetes mellitus; contemporary glycemic control management of these patients to minimize perioperative complications are reviewed. Goal directed fluid therapy remains an area on interest and controversy; the use of albumin as a resuscitation fluid and recent clinical trial data is reviewed. Delirium is characterized as an acute confusional state occurring in 20-25% of patients after cardiac surgery. Insights on integrating the whole interdisciplinary team, including the family, with the DELirium Team Approach (DELTA) program are discussed. Optimal management for refractory hypoxemia with venovenous extracorporeal membrane oxygenation (VV-ECMO) and the role of prone positioning remain a question. Data supporting this technique during VV-ECMO is reviewed-lastly, the contemporary management and supporting evidence for refractory postoperative vasoplegic shock after cardiopulmonary bypass is provided.
摘要：
今年,我们再次就心脏手术患者和需要体外膜氧合的患者的围手术期和重症监护管理的几个关键主题收集了专家意见。接受心脏手术的患者中约有三分之一患有糖尿病；回顾了这些患者的当代血糖控制管理，以最大程度地减少围手术期并发症。目标定向液体治疗仍然是一个值得关注和争议的领域；对白蛋白作为复苏液的使用以及最近的临床试验数据进行了回顾。谵妄的特征是心脏手术后20-25％的患者发生急性混乱状态。整合整个跨学科团队的见解，包括家庭,讨论了DELirium团队方法(DELTA)计划。静脉静脉体外膜氧合（VV-ECMO）难治性低氧血症的最佳管理和俯卧定位的作用仍然是一个问题。最后，回顾了VV-ECMO期间支持此技术的数据，提供了体外循环术后顽固性血管麻痹性休克的当代治疗和支持证据。
