Recent advances in critical care medicine relevant to cardiac surgery

Many advances have taken place in intensive care, which are based on large multicentre randomised controlled trials or large observational studies which control for multiple variables. Of particular importance to cardiac surgery patients have been the NICE study of glycaemic control in ICU and the SAFE study of fluid resuscitation in ICU. These studies have established the standard of care for the control of glycaemia in ICU patients and the conditions which require albumin fluid resuscitation as opposed to crystalloid resuscitation in ICU and vice versa. A large study of resuscitation with starch is currently under way. There is also remaining concern about the effect of blood on outcome in cardiac surgery patients. Observational studies have established an independent association between the transfusion of older red cells and increased risk of death in ICU patients. Such findings suggest caution with excessive transfusion after cardiac surgery and the need for a large randomised controlled trial.