ERAS Guidelines for Perioperative Care in Cardiac Surgery

An example of how products and companies have creeped into our cardiac surgery guidelines. The ERAS recommendations for chest tube patency do not mention about the use of suction ( most commonly -20cmH2O) applied to the drainage chambers connected to the chest tubes after shifting the patient to ICU. This is the most commonly utilised procedure used to prevent tamponade. It works very well and is used in almost all major cardiac centers. I would like to ask the authors, why no mention is made of such an important step to maintain chest tube patency. Instead they have stressed on Active chest tube clearance ( apparently a product) and all the references are about that product in the name of active chest tube clearance. There are two authors who are on the board of the company making the product. I feel that mention of the use of suction should be included in the chest tube patency section which is used worldwide and help to prevent cardiac tamponade. I would appreciate the views of other senior colleagues. These are guidelines used worldwide and I am disappointed to see the omission of this important step and promotion of a product in the name of active chest tube clearance in all the references cited. The current and future generations of cardiac surgeons will forget about the importance of suction applied post operatively if they follow these guidelines which has no mention of his important step and is promoting a product. I appeal to all the senior collegaues to share their views.