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Indications for intensive care unit care after carotid endarterectomy
1Critical Care Division Hôtel-Dieu de Montréal, Que.
Insights
Post-carotid endarterectomy intensive care unit (ICU) admissions should be based on major recovery room (RR) complications. Absence of RR complications strongly predicts uneventful ICU recovery, making routine ICU admission unnecessary for low-risk patients.
Area of Science:
- Vascular Surgery
- Critical Care Medicine
- Neurosurgery
Background:
- Carotid endarterectomy is a common procedure to prevent stroke.
- Postoperative complications can occur, necessitating intensive care unit (ICU) monitoring.
- Identifying risk factors for complications is crucial for optimizing patient care.
Purpose of the Study:
- To detail complications following carotid endarterectomy.
- To describe interventions in the ICU post-procedure.
- To identify preoperative and recovery room (RR) risk markers for complications.
Main Methods:
- Retrospective case study of 101 patients undergoing carotid endarterectomy.
- Data collected included demographic information, Goldman cardiac risk index, and Therapeutic Intervention Scoring System (TISS) scores.
- Complications in the recovery room (RR) and ICU were analyzed.
Main Results:
- The majority of interventions in the RR and ICU focused on managing hypertension.
- Neurologic events occurred in 5 patients, and 2 suffered myocardial infarctions.
- Absence of major RR complications had a 97% negative predictive value for subsequent ICU events.
Conclusions:
- Admission to the ICU after carotid endarterectomy should be guided by the occurrence of major RR complications.
- Routine ICU admission is not warranted for patients with low TISS scores and no major complications in the RR.
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.