Lee Lawrence S, Clark Aaron J, Namburi Niharika, Naum Chris C, Timsina Lava R, Corvera Joel S, Beckman Daniel J, Everett Jeffrey E, Hess Philip J
Division of Cardiothoracic Surgery, Indiana University Health Methodist Hospital, Indiana University School of Medicine, Indianapolis, Indiana.
Division of Pulmonary and Critical Care Medicine, Indiana University Health Methodist Hospital, Indiana University School of Medicine, Indianapolis, Indiana.
J Card Surg. 2020 Apr;35(4):787-793. doi: 10.1111/jocs.14457. Epub 2020 Feb 12.
Postoperative critical care management is an integral part of cardiac surgery that contributes directly to clinical outcomes. In the United States there remains considerable variability in the critical care infrastructure for cardiac surgical programs. There is little published data investigating the impact of a dedicated cardiac surgical intensive care service.
A retrospective study examining postoperative outcomes in cardiac surgical patients before and after the implementation of a dedicated cardiac surgical intensive care service at a single academic institution. An institutional Society of Thoracic Surgeons database was queried for study variables. Primary endpoints were the postoperative length of stay, intensive care unit length of stay, and mechanical ventilation time. Secondary endpoints included mortality, readmission rates, and postoperative complications. The effect on outcomes based on procedure type was also analyzed.
A total of 1703 patients were included in this study-914 in the control group (before dedicated intensive care service) and 789 in the study group (after dedicated intensive care service). Baseline demographics were similar between groups. Length of stay, mechanical ventilation hours, and renal failure rate were significantly reduced in the study group. Coronary artery bypass grafting patients observed the greatest improvement in outcomes.
Implementation of a dedicated cardiac surgical intensive care service leads to significant improvements in clinical outcomes. The greatest benefit is seen in patients undergoing coronary artery bypass, the most common cardiac surgical operation in the United States. Thus, developing a cardiac surgical intensive care service may be a worthwhile initiative for any cardiac surgical program.
术后重症监护管理是心脏手术不可或缺的一部分，直接影响临床结局。在美国，心脏外科项目的重症监护基础设施仍存在很大差异。关于专门的心脏外科重症监护服务的影响，发表的数据很少。
一项回顾性研究，考察在一家单一学术机构实施专门的心脏外科重症监护服务前后心脏手术患者的术后结局。查询机构的胸外科医师协会数据库以获取研究变量。主要终点为术后住院时间、重症监护病房住院时间和机械通气时间。次要终点包括死亡率、再入院率和术后并发症。还分析了基于手术类型对结局的影响。
本研究共纳入1703例患者，对照组（专门重症监护服务实施前）914例，研究组（专门重症监护服务实施后）789例。两组间基线人口统计学特征相似。研究组的住院时间、机械通气时长和肾衰竭发生率显著降低。冠状动脉搭桥术患者的结局改善最为明显。
实施专门的心脏外科重症监护服务可显著改善临床结局。在美国最常见的心脏手术——冠状动脉搭桥术患者中获益最大。因此，对于任何心脏外科项目而言，开展心脏外科重症监护服务可能是一项值得推行的举措。
