The intensive care unit (ICU)  nurse’s role in reducing  complications after cardiac  surgery: An integrative  review

Joanne Mason; Paula Foran

doi:10.26550/2209-1092.1396

Authors

Joanne Mason MCN (Critical Care Nursing), RN
Dr Paula Foran PhD, RN, FACORN, FACPAN, MACN

DOI:

https://doi.org/10.26550/2209-1092.1396

Keywords:

cardiac surgery, intensive care unit, post-operative complications, nursing interventions, pre-operative education, early detection, prevention

Abstract

Introduction: Perioperative nursing begins at the start of a surgical admission and continues until patient discharge, thus encompassing nursing care provided in the intensive care unit (ICU). Cardiac surgery is associated with high rates of post-operative complications that significantly increase mortality, morbidity and length of hospital stay. Many of these complications occur early in the post-operative period within the ICU, where nurses are central to monitoring, prevention and timely intervention. Despite this, nursing contributions are often under-represented in the literature compared with medical or surgical perspectives.
This integrative review investigated the common post-operative complications following cardiac surgery and the role of ICU nurses in reducing the risk of such complications.
Methods: A comprehensive search was conducted across Scopus, HealthSource: Nursing/Academic Edition, CINAHL and MEDLINE. Studies published in English within the last five years were included if they focused on the nursing role in the ICU following cardiac surgery. A total of 26 studies met the inclusion criteria and methodological quality was appraised using appropriate EQUATOR Network tools.
Findings: Four key themes emerged: respiratory complications, cardiovascular complications, acute kidney injury and post-operative delirium. Evidence highlighted that vigilant monitoring, structured assessment protocols, pre-operative education, early mobilisation, advocacy for pharmacological interventions and family involvement are pivotal nursing strategies that improve outcomes. However, limited standardisation of protocols and inconsistent implementation were noted across studies, possibly reflecting gaps in the literature rather than clinical practice.
Conclusion: Intensive care unit nurses play a critical role in the early post-operative phase following cardiac surgery. Nurse-led, evidence-based interventions can significantly reduce the incidence of post-operative complications, improve recovery and enhance survival. Further multicentre, nursing-focused research is needed to validate interventions, strengthen implementation strategies and develop standardised guidelines for practice.

References

Udzik J, Sienkiewicz S, Biskupski A, Szylińska A, Kowalska Z, Biskupski P. Cardiac complications following cardiac surgery procedures [Internet]. J Clin Med. 2020 [cited 2025 Oct 18];9(10):3347. DOI: 10.3390/ jcm9103347

Seese L, Sultan I, Gleason TG, Navid F, Wang Y, Thoma F, Kilic A. The impact of major postoperative complications on longterm survival after cardiac surgery [Internet]. Ann Thorac Surg. 2020[cited 2025 Oct 18];110(1):128–35. DOI: 10.1016/j.athoracsur.2019.09.100

Wang Y, Wang B. Risk factors of delirium after cardiac surgery: A systematic review and meta-analysis [Internet]. J Cardiothorac Surg. 2024[cited 2025 Oct 18];19(1):675. DOI: 10.1186/s13019024031561

Pahwa S, Bernabei A, Schaff H, Stulak J, Greason K, Pochettino A, Daly R, Dearani J, Bagameri G, King K, Viehman J. Impact of postoperative complications after cardiac surgery on longterm survival [Internet]. J Card Surg. 2021[cited 2025 Oct 18];36(6):2045–52. DOI: 10.1111/jocs.15471

Kim M, Kim Y, Choi M. Intensive care unit nurses’ experiences of nursing concerns, activities, and documentation on patient deterioration: A focus group study [Internet]. Aust Crit Care. 2025[cited 2025 Oct 18];38(2):101126. DOI: 10.1016/j. aucc.2024.09.011

Whittemore R, Knafl K. The integrative review: Updated methodology [Internet]. J Adv Nurs. 2005[cited 2025 Oct 18];52(5):546–53. DOI: 10.1111/j.13652648.2005.03621.x

Zochios V, Chandan JS, Schultz MJ, Morris AC, Parhar KK, GiménezMilà M et al. The effects of escalation of respiratory support and prolonged invasive ventilation on outcomes of cardiac surgical patients: A retrospective cohort study [Internet]. J Cardiothorac Vasc Anesth. 2020[cited 2025 Oct 18];34(5):1226–34. DOI: 10.1053/j. jvca.2019.10.052

Setlers K, Jurcenko A, Arklina B, Zvaigzne L, Sabelnikovs O, Stradins P et al. Identifying early risk factors for postoperative pulmonary complications in cardiac surgery patients [Internet]. Medicina (Kaunas). 2024[cited 2025 Oct 18];60(9). DOI: 10.3390/medicina60091398

O’Brien SM, Feng L, He X, Xian Y, Jacobs JP, Badhwar V et al. The society of thoracic surgeons 2018 adult cardiac surgery risk models: Part 2—statistical methods and results [Internet]. Ann Thorac Surg. 2018[cited 2025 Oct 18];105(5):1419–28. DOI: 10.1016/j.athoracsur.2018.03.003

Wang Y, Zhu S, Liu X, Zhao B, Zhang X, Luo Z et al. Linking preoperative and early intensive care unit data for prolonged intubation prediction [Internet]. Front Cardiovasc Med. 2024[cited 2025 Oct 18];11:1342586. DOI: 10.3389/ fcvm.2024.1342586

Carini FC, Lillo E, Vecchio G, Giannasi S, Castro DM. Optimal sedation in ventilated patients with cardiovascular surgery and/or shock [Internet]. Crit Care Clin. 2025[cited 2025 Oct 18]. DOI: 10.1016/j. ccc.2025.05.006

Pazar B, Iyigun E. The effects of preoperative education of cardiac patients on haemodynamic parameters, comfort, anxiety and patientventilator synchrony: A randomised, controlled trial [Internet]. Intensive Crit Care Nurs. 2020[cited 2025 Oct 18];58. DOI: 10.1016/j.iccn.2020.102799

Esmealy L, Allahbakhshian A, Gholizadeh L, Khalili AF, Sarbakhsh P. Effects of early mobilization on pulmonary parameters and complications post coronary artery bypass graft surgery [Internet]. Appl Nurs Res. 2023[cited 2025 Oct 18];69. DOI: 10.1016/j.apnr.2022.151653

Zhang RJZ, Yu XY, Wang J, Lv J, Zheng Y, Yu MH et al. A prediction model for new onset atrial fibrillation following coronary artery bypass graft surgery: A multicenter retrospective study [Internet]. Heliyon. 2023[cited 2025 Oct 18];9(3). DOI: 10.1016/j.heliyon.2023.e14656

Egan S, Collins Smyth C, Chitnis S, Head J, Chiu A, Bhatti G et al. Prevention of postoperative atrial fibrillation in cardiac surgery: A quality improvement project [Internet]. Can J Anesth. 2023[cited 2025 Oct 18];70(12):1880–91. DOI: 10.1007/s12630-023-02619-8

Damstra J, Geerts BF, Rex S, Vlaar APJ, Driessen AHG, Engelman DT et al. Perioperative care standards in cardiac surgery patients aiming at enhancing recovery: A nationwide survey in the Netherlands and Belgium [Internet]. J Cardiothorac Vasc Anesth. 2022[cited 2025 Oct 18];36(1):109–17. DOI: 10.1053/j.jvca.2021.08.106

Niessen R, Rancati V, VerdugoMarchese M, Gunga Z, Nowacka A, Melly V et al. Effect of enhanced recovery after surgery (ERAS) implementation on postoperative atrial fibrillation in cardiac surgery [Internet]. Biomedicines. 2025[cited 2025 Oct 18];13(5). DOI: 10.3390/biomedicines13051212

Andugala S, McIntosh A, Orchard J, Rahiman S, Miedecke A, Keyser J et al. Successful implementation of enhanced recovery after surgery (ERAS) in paediatric cardiac surgery in Australia [Internet]. Heart Lung Circ. 2024[cited 2025 Oct 18];33(8):1201-8. DOI: 10.1016/j. hlc.2024.04.001

Al Attar N, Johnston S, Jamous N, Mistry S, Ghosh E, Gangoli G et al. Impact of bleeding complications on length of stay and critical care utilization in cardiac surgery patients in England [Internet]. J Cardiothorac Surg. 2020[cited 2025 Oct 18];14(1). DOI: 10.1186/s1301901908813

Reisdorfer AP, Leal SM, Mancia JR. Nursing care for patient in postoperatory heart surgery in the intensive care unit [Internet]. Rev Bras Enferm. 2021[cited 2025 Oct 18];74:e20200163. DOI: 10.1590/0034716720200163

Lavoie P, Arbour C, Garneau AB, Côté J, Crétaz M, Denault A et al. A dimensional analysis of experienced intensive care unit nurses’ clinical decision-making for bleeding after cardiac surgery [Internet]. Nurs Crit Care. 2024[cited 2025 Oct 18];29(5):1119–31. DOI: 10.1111/nicc.13116

Moh’d A, Khasawneh M, Odwan H, Alghoul Y, Makahleh Z, Altarabsheh S. Postoperative cardiac arrest in cardiac surgery – how to improve the outcome? [Internet]. Med Arh. 2021[cited 2025 Oct 18];75(2):149–53. DOI: 10.5455/medarh.2021.75.149153

Moskowitz A, Berg KM, Cocchi MN, Chase M, Yang JX, Sarge J et al. Cardiac arrest in the intensive care unit: An assessment of preventability [Internet]. Resuscitation. 2019[cited 2025 Oct 18];145:15–20. DOI: 10.1016/j.resuscitation.2019.09.003

Weber MP, Strobel RJ, Norman AV, Kareddy A, Young A, Young S et al. Cardiac surgical unit advanced life support–certified centers are associated with improved failure to rescue after cardiac arrest: A propensity score–matched analysis [Internet]. J Thorac Cardiovasc Surg. 2025 Apr 1[cited 2025 Oct 18];169(4):1271–81. DOI: 10.1016/j.jtcvs.2024.08.014

Just IA, Alborzi F, Godde M, Ott S, Meyer A, Stein J et al. Cardiac surgeryrelated acute kidney injury – risk factors, clinical course, management suggestions [Internet]. J Cardiothorac Vasc Anesth. 2022[cited 2025 Oct 18];36(2):444–51. DOI: 10.1053/j. jvca.2021.05.012

Marco PS, Nakazone MA, Maia LN, Machado MN. Cardiac surgeryassociated acute kidney injury in patients with preserved baseline renal function [Internet]. Rev Bras Cir Cardiovasc. 2022[cited 2025 Oct 18];37(5):613–21. DOI: 10.21470/1678974120220108

Kidney disease: Improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury [Internet]. Kidney Int Suppl. 2012[cited 2025 Oct 18];2(1):1–138. DOI: 10.1038/kisup.2012.1

Schanz M, Schöffski O, Kimmel M, Oberacker T, Göbel N, Franke UFW et al. Underrecognition of acute kidney injury after cardiac surgery in the ICU impedes early detection and prevention [Internet]. Kidney Blood Press Res. 2022[cited 2025 Oct 18];47(1):50–60. DOI: 10.1159/000519536

Segernäs A, Skoog J, Ahlgren Andersson E, Almerud Österberg S, Thulesius H, Zachrisson H. Prediction of postoperative delirium after cardiac surgery with a quick test of cognitive speed, Minimental state examination and hospital anxiety and depression scale [Internet]. Clin Interv Aging. 2022[cited 2025 Oct 18];17:359–68. DOI: 10.2147/CIA.S350195

Habeeb Allah A, Alshraideh JA. Delirium postcardiac surgery: Incidence and associated factors [Internet]. Nurs Crit Care. 2021[cited 2025 Oct 18];26(3):150–5. DOI: 10.1111/nicc.1249

Guo Y, Li C, Mu Y, Wu T, Lin X. Incidence and associated factors of postoperative delirium in adults undergoing cardiac surgery with cardiopulmonary bypass: A prospective cohort study [Internet]. J Clin Nurs. 2025[cited 2025 Oct 18];34(9):3811-25. DOI: 10.1111/jocn.17596

Hamadnalla H, Sessler DI, Troianos CA, Fang J, Rivas E, Ma C et al. Optimal interval and duration of CAMICU assessments for delirium detection after cardiac surgery [Internet]. J Clin Anesth. 2021[cited 2025 Oct 18];71. DOI: 10.1016/j.jclinane.2021.110233

Kalkan A, Digin F. The effect of informing patients with video before cardiac surgery on intensive care experience: A randomized controlled trial [Internet]. Pak J Med Sci. 2024[cited 2025 Oct 18];40(6). DOI: 10.12669/pjms.40.6.8627

Lin X, Tian N, Wang Y, Hua S, Kong J, Xu S et al. Development and validation of a postoperative delirium risk prediction model for noncardiac surgery in elderly patients [Internet]. Front Psychiatry. 2025 Apr 28[cited 2025 Oct 18];16:1414273. DOI: 10.3389/fpsyt.2025.1414273

Koyuncu A, Yava A, Yamak B, Orhan N. Effect of family presence on stress response after bypass surgery [Internet]. Heart Lung. 2021[cited 2025 Oct 18];50(2):193–201. DOI: 10.1016/j.hrtlng.2020.11.006

Azimzadeh D, Lapierre A, Bouaouina Z, Williamson D, Mailhot T, Arbour C. ICU nurses’ perceptions on family involvement in delirium care for postoperative cardiac surgery patients: A qualitative study [Internet]. Intensive Crit Care Nurs. 2025[cited 2025 Oct 18];88. DOI: 10.1016/j. iccn.2025.104001