## 4 Discussion  
This review focused on the applicability of CDSSs, databases, CPOE, and EHRs in cardiac surgery patients in ICUs. The objectives were focused on summarizing the recent scientific evidence on this subject in order to investigate clinical decision support systems. Decision-making aids have been studied in different fields and types of patients. The results showed an emerging area associated with the development forecast. Some studies referred to CDSSs, analyzing the predisposing parameters and supporting the forecast of the evolution and the readmission that a patient may present [56; 67; 68]. CDSSs use multiple parameters to determine the prognostics, such as patient characteristics, comorbidities, reasons for admission, and scales [55; 73]. Specifically, the studies of [PERSON] et al. referred to the prediction of development in said studies. Both studies focused on patients with neurocritical and periventricular leukomalacia patients. They reported that a rapid prediction of a patient's development can reduce mortality levels or hospital stay, among others [55; 56]. The databases through CDSSs, including the parameters, proved their usefulness in predicting evolution, such as demographic data, laboratory data, and admission diagnoses [57; 67]. Some reviews support the above. These reviews focused extensively on analyzing the prediction ranges of tools such as databases or CDSSs [74; 75]. Another result that emerged strongly in the selected articles was medical errors. Specifically, the tools applied to CPOE systems were assessed in relation to their strong impact on the prevention of drug-related errors [63; 69; 70; 71]. According to the evidence, CPOE tools prevent the wrong administration of drugs and help to make dosage adjustments considering comorbidities, which are among the most common confounding factors [76; 77; 78]. These dose modifications could eventually lead to a reduction in critical events such as cardiorespiratory arrest [71]. In addition, the results indicate that drug administration times were significantly reduced after the use of CPOE. Among the studies that were analyzed, the improvement in healthcare after the use of CPOE is meaningful, since errors of administration were recorded before and after its application, and a reduction was observed [63; 69; 70; 71]. The reduction in the incidence of drug administration errors and the reduction in time to administration is of paramount importance in the pandemic situation because of the shortage in resources in critical care settings, and it must not be overlooked [79; 80]. Although this situation does not directly affect the tasks usually performed by physicians or nursing professionals, it is considered one of the most limiting factors in providing the necessary care on time, so any tool capable of alleviating burdens should be considered potentially useful [78]. Moreover, the results suggest that these tools can detect difficulties in a patient's situation for rapid action [54; 64; 65]. Considering the evidence, CDSSs and EHRs allow continuous monitoring for detecting clinical alterations at the precise moment they take place. This is relevant in postoperative patients, as they have a greater risk of suffering significant complications [79]. CDSSs also offer a precise adjustment of dosage or flux to maintain a variable in the desired range [51; 52; 53; 54; 59; 61]. Some examples of the already developed CDSSs on this subject matter belong to the field of hemodynamic advanced measurement devices, such as cardiac output (CO) [53; 59]. These studies dealt with the utilization of a CDSS combined with a continuous monitor of cardiovascular function [52; 54]. The systems were able to select and advise reasonable treatments under different clinical conditions [51]. These systems are able to select and advise reasonable treatments under different clinical conditions.