Fast-track cardiac anaesthesia protocols: Is quality pushed to the edge?

Area of Science:

• Anesthesiology
• Critical Care Medicine
• Cardiac Surgery

Background:

• Fast-track cardiac anesthesia protocols aim to expedite postoperative patient turnover.
• Previous randomized controlled studies (RCTs) evaluated three different protocols from 2010-2016.
• This study retrospectively analyzed control groups to assess recovery quality and patient comfort.

Purpose of the Study:

• To evaluate the association between fast-track protocols, patient turnover metrics, and recovery quality.
• To determine if reduced ventilation time and length of stay come at the expense of patient comfort and recovery quality.

Main Methods:

• Retrospective analysis of 90 control patients from three RCTs.
• Evaluation of time parameters (ventilation time, length of stay).
• Assessment using an objective/semi-objective Intensive Care Unit (ICU) score system (IDS score) and postoperative morphine requirement.

Main Results:

• Ventilation time significantly decreased in the latest protocol (205 min) compared to earlier ones (293 min, 261 min).
• Intensive Care Unit (ICU) score was lowest in the earliest study, with the latest study showing scores marginally above discharge eligibility.
• Postoperative morphine requirement significantly increased in the latest protocol (26.5 mg) compared to earlier studies (15.0 mg, 10.0 mg).

Conclusions:

• Strict fast-track protocols reduce ventilation time but do not lead to earlier ICU discharge eligibility.
• The implementation of these protocols appears to challenge the quality of patient recovery and comfort.