Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
J Cardiothorac Vasc Anesth. 2019 Jul;33(7):1845-1851. doi: 10.1053/j.jvca.2019.02.012. Epub 2019 Feb 13.
To identify reliable predictors of periprocedural intensive care unit (ICU) admission after transvenous lead extraction (LE) in a high-volume center.
Retrospective observational study.
University tertiary-care hospital.
All patients undergoing LE at San Raffaele Scientific Institute, Milan, Italy, from 2005 to 2015.
LE procedures were performed in the electrophysiology laboratories with a cardiac operating room on standby between the end of the morning surgical case and before the start of the afternoon surgical case. Most procedures were conducted with the patient under procedural sedation and analgesia. After LE, patients were admitted either to the ward or to the ICU. Medical history and intraprocedural data were recorded.
Of the 389 procedures performed during the study period, 50 patients (13%) were admitted to the ICU owing to persistent hemodynamic instability or intraoperative complications requiring endotracheal intubation. Complete procedural success was achieved in 370 patients (95%), and the clinical success rate was 98.4%. No deaths were recorded. Five complications requiring emergency surgery (1.3%) were reported. Preprocedural right ventricular dysfunction (odds ratio (OR) 7.41; confidence interval 1.85-29.7; p < 0.01) and the need for general anesthesia (OR 12; confidence interval 1.49-97.06; p = 0.019) were independent predictors of ICU admission.
Preoperative identification of patients who need ICU admission after LE is crucial to increase patient safety and decrease hospital costs. Severe right ventricular dysfunction and need for general anesthesia identify patients with low cardiac reserve who are at increased risk for ICU admission after the procedure.
在高容量中心确定经静脉导线拔除（LE）后入住围手术期重症监护病房（ICU）的可靠预测因素。
回顾性观察性研究。
意大利米兰圣拉斐尔科学研究所的大学三级保健医院。
2005 年至 2015 年期间在米兰圣拉斐尔科学研究所接受 LE 的所有患者。
LE 手术在电生理实验室进行，当上午手术结束后和下午手术开始前，心脏手术室随时待命。大多数手术都是在患者进行程序镇静和镇痛下进行的。LE 后，患者被收入病房或 ICU。记录了病史和术中数据。
在研究期间进行的 389 例手术中，由于持续的血流动力学不稳定或需要气管插管的术中并发症，有 50 例（13%）患者入住 ICU。370 例患者（95%）达到了完全手术成功，临床成功率为 98.4%。没有死亡记录。报告了 5 例需要紧急手术的并发症（1.3%）。术前右心室功能障碍（优势比（OR）7.41；置信区间 1.85-29.7；p < 0.01）和需要全身麻醉（OR 12；置信区间 1.49-97.06；p = 0.019）是 ICU 入住的独立预测因素。
术前识别需要 LE 后入住 ICU 的患者对于提高患者安全性和降低医院成本至关重要。严重的右心室功能障碍和全身麻醉的需要可以识别出心脏储备能力低的患者，这些患者在手术后入住 ICU 的风险增加。
