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In some centres, selected cardiac surgical patients are monitored following surgery in facilities other than designated ICUs. These are variously referred to as the high dependency unit, cardiac recovery or cardiac fast-track unit. These areas aim to minimise the period of mechanical ventilation and improve outcomes. The equipment, monitoring and staffing requirements for such a facility are no less than...

Where possible, point of care or near-patient testing should be used for blood gas analysis, measurement of electrolytes and blood sugar, haemoglobin, lactate and coagulation. This testing should include platelet function, thromboelastography or rotational thromboelastometry and early acute kidney injury urinary markers.²⁶ The need for direct oral anticoagulant analysis at point of care should be carefully considered^.27

Immediate access to expert haematology advice, haematology laboratory services and blood products and factor replacements should be available.

There should be immediate access to expert radiology advice, x-ray facilities and computed axial tomography services for patients undergoing cardiac surgery.

Access to measurements of respiratory function should be available for patients undergoing cardiac surgery, including a facility for cardiopulmonary exercise testing.

Physiotherapy services should be available during the preoperative preparation and postoperative care of patients undergoing cardiac surgery.

All anaesthetic equipment should be checked before use in accordance with the Association of Anaesthetists published guidelines. Anaesthetic machine checks should be recorded in a log and on the anaesthetic chart.

Pain relief protocols should be clearly defined for cardiac surgery patients.

For cardiac patients, dedicated echocardiography equipment, including transoesophageal echo, should be immediately available in the operating suite and postoperative care areas. Those who deliver intraoperative echocardiography services should be trained to the level of competence defined by specialist bodies.^29,30