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Does modern cardiac surgery require conventional intensive care?

S Westaby1, R Pillai, A Parry

  • 1Oxford Heart Centre, John Radcliffe Hospital, Headington, UK.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|January 1, 1993
PubMed
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Early extubation after cardiac surgery is safe and effective using a cardiac recovery area (CRA) staffed by nurse practitioners, reducing intensive care unit (ITU) dependency. This approach allows for a higher daily surgical volume and shorter patient stays.

Area of Science:

  • Cardiovascular Surgery
  • Intensive Care Medicine
  • Anesthesiology

Background:

  • Modern cardiopulmonary bypass techniques and mild hypothermia have advanced cardiac surgery.
  • Protracted post-operative ventilation in an intensive care unit (ITU) may not be necessary for all cardiac operations.

Purpose of the Study:

  • To evaluate the safety and efficacy of an early extubation policy using a dedicated cardiac recovery area (CRA).
  • To assess the feasibility of managing post-cardiac surgery patients in a CRA as an alternative to the ITU.

Main Methods:

  • A prospective study of 1,000 cardiac surgery patients managed in a three-bedded CRA between January 1990 and June 1991.
  • Early extubation was the standard policy, with 45 high-risk patients managed in the ITU.
  • Patient care was led by nurse specialists and supported by cardiac surgeons, with limited anaesthetist/intensivist intervention.

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Main Results:

  • The median time to extubation varied by procedure: coronary bypass (2.0 hours), aortic valve (2.5 hours), mitral valve (3.0 hours), and double-valve (3.0 hours).
  • The CRA facilitated a rapid bed turnover, allowing 5-6 operations daily.
  • Overall mortality in the CRA was 1.4%, with a mean post-operative stay of 7 days. Ten patients (1%) required transfer to the ITU due to complications.

Conclusions:

  • A cardiac recovery area staffed by nurse practitioners offers a safe and effective alternative to ITU management for selected post-cardiac surgery patients.
  • Early extubation and CRA utilization can improve hospital resource management by increasing operating room throughput.
  • This model reduces reliance on ITU beds, potentially alleviating critical care capacity constraints.