Salhiyyah Kareem, Elsobky Sherif, Raja Shahzad, Attia Rizwan, Brazier John, Cooper Graham J
Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, United Kingdom.
Heart Surg Forum. 2011 Dec;14(6):E330-4. doi: 10.1532/HSF98.20111029.
In the last 5 decades, the care of cardiac surgical patients has improved with the aid of strategies aimed at facilitating patient recovery. One of the innovations in this context is "fast-tracking" or "rapid recovery." This process refers to all interventions that aim to shorten a patient's stay in the intensive care unit (ICU) through accelerating the patient's transfer to a step-down or telemetry unit and to the general ward.
Patients were allocated to 2 groups. The fast-track group (n = 84) went through an independent theatre recovery unit (TRU). The patients were then transferred on the same day to an intermediate care unit and transferred on the following day to the ward. The intensive care group (52 patients) went to the ICU for at least 1 day, after which they were transferred to the ward.
The fast-track pathway significantly reduced the length of stay (LOS) in an intensive care facility (P < .001). The duration of intubation was reduced from a median of 4.08 hours (range, 1.17-13.17 hours) in the intensive care group to 2.75 hours (range, 0.25-18.57 hours) in the fast-track group (P < .001). However, the median values for total hospital LOS, incidences of complications, reintubation, and readmission were similar for the 2 groups. The incidence of failure in the fast-track group was 10%. The mean (SD) cost of the perioperative care was £4182 ± £2284 ($6683 ± 3650) for the fast-track patients, compared with £4553 ± £1355 ($7277 ± $2165) for the intensive care group.
Fast-track recovery after cardiac surgery decreases the intensive care LOS and the total duration of intubation. It is a cost-effective strategy compared with conventional recovery protocols; however, it does not reduce the total hospital LOS or the incidence of complications.
在过去的50年里，借助旨在促进患者康复的策略，心脏外科手术患者的护理得到了改善。在这种情况下的一项创新是“快速康复”或“快速恢复”。这个过程指的是所有旨在通过加速患者转至降级护理病房或遥测病房以及普通病房来缩短患者在重症监护病房（ICU）停留时间的干预措施。
将患者分为两组。快速康复组（n = 84）通过独立的手术室恢复单元（TRU）。然后患者在同一天转至中级护理病房，并在第二天转至普通病房。重症监护组（52例患者）在ICU至少停留1天，之后转至普通病房。
快速康复路径显著缩短了重症监护病房的住院时间（LOS）（P <.001）。插管持续时间从重症监护组的中位数4.08小时（范围1.17 - 13.17小时）降至快速康复组的2.75小时（范围0.25 - 18.57小时）（P <.001）。然而，两组的总住院时间、并发症发生率、再次插管率和再入院率的中位数相似。快速康复组的失败发生率为10%。快速康复患者围手术期护理的平均（标准差）费用为4182±2284英镑（6683±3650美元），而重症监护组为4553±1355英镑（7277±2165美元）。
心脏手术后的快速康复可缩短重症监护病房住院时间和总插管持续时间。与传统康复方案相比，这是一种具有成本效益的策略；然而，它并不能缩短总住院时间或降低并发症发生率。
