Congenital Heart Institute at Arnold Palmer Hospital for Children, Orlando, FL 32806, USA.
Nurs Crit Care. 2011 Nov-Dec;16(6):281-6. doi: 10.1111/j.1478-5153.2011.00455.x. Epub 2011 Jul 20.
The impact of a designated intensive care unit (ICU) for postoperative cardiac care in children is not clear. In our hospital (in the USA), we started a new Paediatric Cardiac Surgery programme 5 years ago, in September 2004. During the first 2 years of the programme, postoperative care was accomplished within the general paediatric ICU (PICU or c-ICU). Subsequently, in September 2006, a dedicated cardiac ICU (d-ICU) was established. We looked at our experience during these two periods to determine whether the designation of a separate ICU affected outcomes for these children.
We obtained Institutional Review Board (IRB) approval to review the medical records for all postoperative cardiac admissions to the ICU during the first 4 years of the programme (September 2004-September 2008). Variables collected included age, gender, diagnosis, type of cardiac surgery, Risk Adjustment for Congenital Cardiac Surgery, version 1 (RACHS-1) classification, ventilator use, hospital stay, invasive line infections, ventilator-related infections, wound infections, need for cardiopulmonary support, return to the operating room, re-exploration of the chest, delayed sternal closure, accidental extubations, re-intubation and mortality rates. These variables were summed and compared for the combined PICU and the dedicated paediatric cardiac ICU.
There were 199 cases performed in the first 2 years compared with 244 in the following 2 years. We saw a statistically insignificant increase in the number and complexity of cases during the second period (p = 0·08). However, morbidity declined as evidenced by the decrease in wound infection (p < 0·001) and need for chest re-exploration (p < 0·001). In addition, mortality declined from 7 of 199 (3·5%) to 2 of 244 (0·8%). p < 0·04 and less children required resuscitation (p < 0·01).
We believe the designation of a specific area for postoperative cardiac care was instrumental in the growth and development of our cardiac programme. This rapid change accomplished several crucial elements that lead to accelerated improvement in patient care and a decline in morbidity and mortality.
专门的重症监护病房（ICU）对儿童术后心脏护理的影响尚不清楚。在美国的我院，我们于 2004 年 9 月启动了一个新的儿科心脏手术项目。在该项目的头 2 年，术后护理在普通儿科 ICU（PICU 或 c-ICU）内完成。随后，在 2006 年 9 月，建立了专门的心脏 ICU（d-ICU）。我们回顾了这两个时期的经验，以确定是否指定一个单独的 ICU 会影响这些儿童的预后。
我们获得机构审查委员会（IRB）的批准，审查了项目前 4 年（2004 年 9 月至 2008 年 9 月）期间所有 ICU 术后心脏入院患者的医疗记录。收集的变量包括年龄、性别、诊断、心脏手术类型、先天性心脏手术风险调整 1 版（RACHS-1）分类、呼吸机使用、住院时间、侵入性线路感染、呼吸机相关感染、伤口感染、心肺支持需求、返回手术室、胸部再次探查、延迟胸骨闭合、意外拔管、重新插管和死亡率。将这些变量相加并比较综合 PICU 和专门的儿科心脏 ICU。
前 2 年共进行了 199 例手术，后 2 年共进行了 244 例手术。我们发现第二期病例数量和复杂性呈统计学上的显著增加（p=0.08）。然而，发病率下降，表现在伤口感染（p<0.001）和需要胸部再次探查（p<0.001）的减少。此外，死亡率从 199 例中的 7 例（3.5%）降至 244 例中的 2 例（0.8%）。p<0.04，且需要复苏的儿童减少（p<0.01）。
我们认为指定一个专门的区域进行术后心脏护理对我们的心脏项目的成长和发展至关重要。这种快速变化实现了几个关键要素，导致患者护理的加速改善，发病率和死亡率下降。
