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Influence of a dedicated paediatric cardiac intensive care unit on patient outcomes
Maher Eldadah1, Sheryl Leo, Kristina Kovach
1Congenital Heart Institute at Arnold Palmer Hospital for Children, Orlando, FL 32806, USA. mahereldadah@yahoo.com
Insights
Establishing a dedicated pediatric cardiac intensive care unit (CICU) significantly improved patient outcomes. The specialized CICU led to reduced wound infections, fewer re-explorations, and lower mortality rates in pediatric cardiac surgery patients.
Area of Science:
- Pediatric Cardiac Surgery
- Intensive Care Medicine
- Healthcare Management
Background:
- The impact of dedicated pediatric cardiac intensive care units (CICUs) on patient outcomes remains unclear.
- A pediatric cardiac surgery program in the USA transitioned from a general pediatric intensive care unit (PICU) to a dedicated CICU after two years of operation.
- This study compares outcomes during the initial period of general PICU care versus the subsequent period of dedicated CICU care.
Purpose of the Study:
- To evaluate the effect of establishing a dedicated pediatric cardiac intensive care unit (CICU) on patient outcomes.
- To compare morbidity and mortality rates between general PICU and dedicated CICU care for pediatric cardiac surgery patients.
- To assess the role of a specialized care environment in the development of a pediatric cardiac surgery program.
Main Methods:
- Retrospective review of medical records for pediatric cardiac surgery patients admitted to the ICU over the first four years of the program (September 2004 - September 2008).
- Data collected included patient demographics, diagnosis, surgical complexity (RACHS-1), ventilator use, length of stay, infection rates (wound, ventilator, invasive line), need for cardiopulmonary support, re-operations, and mortality.
- Outcomes were compared between patients cared for in a general PICU and those in a dedicated CICU.
Main Results:
- The number of cases increased from 199 to 244 over the two periods, with a trend towards increased complexity (p=0.08).
- Significant reductions in morbidity were observed, including decreased wound infection rates (p < 0.001) and fewer re-explorations for chest issues (p < 0.001).
- Mortality decreased from 3.5% (7/199) to 0.8% (2/244) (p < 0.04), with fewer patients requiring resuscitation (p < 0.01).
Conclusions:
- The establishment of a dedicated pediatric cardiac intensive care unit was crucial for the program's growth and improved patient care.
- Specialized care in a dedicated CICU facilitated accelerated improvements in patient outcomes, leading to reduced morbidity and mortality.
- The findings support the benefits of specialized intensive care environments for pediatric cardiac surgery patients.
Background:
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.
Design And Methods:
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.
Results:
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).
Conclusions:
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.
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