Perioperative pulmonary infection prevention and management in adult patients after coronary artery bypass grafting: a summary of best evidence.

BACKGROUND: Coronary artery bypass grafting is an important surgical treatment for coronary heart disease. As an open thoracic procedure, pulmonary infection is a common and potentially serious complication of coronary artery bypass grafting. Its occurrence may prolong mechanical ventilation, increase hospital length of stay, and raise mortality risk. This study therefore aims to evaluate and summarise the evidence for the prevention and management of perioperative pulmonary infection in patients undergoing coronary artery bypass grafting to inform clinical practice. METHODS: This evidence summary adheres to the standardised reporting framework of the Fudan University Centre for Evidence-Based Nursing (Registration No: ES20246831). The process encompassed clinical question identification, evidence retrieval, literature screening, methodological quality assessment, and evidence synthesis and grading. A systematic search was conducted from January 1, 2015, to December 31, 2025, across the following databases: UpToDate; BMJ Best Practice; the UK National Institute for Health and Care Excellence; the Registered Nurses’ Association of Ontario; the National Guideline Clearinghouse; the Scottish Intercollegiate Guidelines Network; the Guidelines International Network; the Cochrane Library; the JBI Evidence Synthesis Database; PubMed; Web of Science; the China National Knowledge Infrastructure; Wanfang Data; and the Medlive Guidelines Network. Literature types included clinical decisions, guidelines, expert consensuses, systematic reviews, and evidence summaries. RESULTS: This study included 19 publications comprising 2 clinical decisions, 2 guidelines, 2 expert consensuses, 6 systematic reviews, and 7 evidence summaries. It synthesised 4 themes and 23 best practice recommendations covering four critical phases: risk assessment and optimisation; preoperative early exercise and prehabilitation; intraoperative safety strategies and anaesthetic management; and postoperative respiratory exercise and rehabilitation. CONCLUSION: This study systematically synthesised 23 evidence-based measures for preventing and managing pulmonary infection in coronary artery bypass grafting patients. Collectively, these measures form a systematic approach to pulmonary infection prevention and management. Implementation of these recommendations may enable healthcare providers globally to enhance the quality and standardization of perioperative coronary artery bypass grafting care, while reducing the incidence of perioperative pulmonary infections and associated prognostic burden.