Ranucci Marco, Bellucci Carmen, Conti Daniela, Cazzaniga Anna, Maugeri Bruno
Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico S. Donato, Milan, Italy.
Ann Thorac Surg. 2007 Mar;83(3):1089-95. doi: 10.1016/j.athoracsur.2006.10.003.
The length of stay in the intensive care unit is one of the factors limiting operating room utilization in cardiac surgery. We investigated the impact of a goal-oriented program aimed at discharging the patients from the intensive care unit the morning after the operation within a comprehensive model including other explanatory variables.
A multivariable predictive model for early discharge from the intensive care unit was established using a stepwise forward logistic regression. The analysis was retrospectively conducted on 9120 consecutive patients undergoing cardiac surgical procedures at our institution.
A total of 1874 patients were discharged early from the intensive care unit. Factors associated with early discharge were ejection fraction, lowest hematocrit on cardiopulmonary bypass, lowest temperature on cardiopulmonary bypass, and the presence of the goal-oriented strategy (odds ratio, 5.5; 95% confidence interval, 4.8 to 6.3). Factors associated with late discharge were age, preoperative serum creatinine value, unstable angina, congestive heart failure, redo operation, combined operation, and cardiopulmonary bypass duration. An extubation time of 4 hours after the arrival in the intensive care unit was associated with the peak rate of early discharge. Patients being early discharged according to the goal-oriented strategy did not demonstrate a different complication rate compared with patients treated with a standard strategy.
Early discharge from the intensive care unit depends on a combination of preoperative and intraoperative factors, but most of all on the presence of a goal-oriented strategy. A very early extubation is not required for an early discharge from the intensive care unit.
重症监护病房的住院时间是限制心脏手术中手术室利用率的因素之一。我们在一个包含其他解释变量的综合模型中，研究了旨在使患者在术后次日早晨从重症监护病房出院的目标导向计划的影响。
使用逐步向前逻辑回归建立了一个从重症监护病房早期出院的多变量预测模型。对我们机构连续进行心脏手术的9120例患者进行了回顾性分析。
共有1874例患者从重症监护病房早期出院。与早期出院相关的因素有射血分数、体外循环时的最低血细胞比容、体外循环时的最低体温以及目标导向策略的实施（比值比，5.5；95%置信区间，4.8至6.3）。与延迟出院相关的因素有年龄、术前血清肌酐值、不稳定型心绞痛、充血性心力衰竭、再次手术、联合手术以及体外循环持续时间。入住重症监护病房后4小时拔管与早期出院的峰值率相关。根据目标导向策略早期出院的患者与采用标准策略治疗的患者相比，并发症发生率并无差异。
从重症监护病房早期出院取决于术前和术中因素的综合作用，但最重要的是目标导向策略的实施。从重症监护病房早期出院并不需要非常早期的拔管。
