Indications for intensive care unit care after carotid endarterectomy.

OBJECTIVES

To describe the complications of carotid endarterectomy and the interventions performed in the intensive care unit (ICU) after carotid endarterectomy. To identify preoperative and recovery room (RR) risk markers for these complications and interventions.

DESIGN

A retrospective case study.

SETTING

The ICU of a university hospital.

PATIENTS

One hundred and one patients who required carotid endarterectomy over a 15-month period.

INTERVENTION

Carotid endarterectomy (bilateral procedures in 11 patients).

OUTCOME MEASURES

Demographic data including Goldman's cardiac risk index and the therapeutic intervention scoring system (TISS) score to measure the risk of complications.

RESULTS

Most of interventions conducted in the RR and ICU were to control high blood pressure. In the RR, three patients experienced a neurologic event, one patient was reintubated for vocal cord paralysis and one had electrocardiographic abnormalities. Overall, 5 of the 101 patients had neurologic complications and 2 suffered a myocardial infarction. Two patients died, one as a result of a massive stroke and the other of myocardial infarction with cardiogenic shock. The mean (and standard deviation) TISS. score in the ICU was 12.6 (3.8). Analysis of all events in the RR was not predictive of events in the ICU. However, the absence of major complications in the RR had a negative predictive value of 97%.

CONCLUSIONS

The decision to admit patients to the ICU after carotid endarterectomy should be based on major complications occurring in the RR. A low TISS score and low incidence of complications does not warrant routine admission.