Cardiac surgery: moving away from intensive care

Chong, J. L.; Pillai, Ravi; Fisher, Anthony; Grebenik, Catherine; Sinclair, M.E.; Westaby, Stephen

doi:10.1136/hrt.68.10.430

Cited by 96 publications

(31 citation statements)

References 6 publications

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“…Changes in postoperative management of cardiac surgical patients owing to growing economic pressure have led to patients being looked after routinely in recovery areas rather than intensive care units (ICUs) [9,10,11]. Predictive models for mortality, morbidity, and intensive care length of stay have been developed for patients undergoing coronary artery bypass grafts (CABGs) for risk assessment and quality control in different institutions [12,13,14,15,16].…”

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confidence: 99%

Risk factors for prolonged ventilation after cardiac surgery using APACHE II, SAPS II, and TISS: comparison of three different models

et al. 2001

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Risk factors for prolonged ventilation after cardiac surgery using APACHE II, SAPS II, and TISS: comparison of three different models

et al. 2001

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“…Prolonged mechanical ventilation increases hospital costs, nursing dependency, airways and lung trauma, as well as stress and discomfort of endotracheal suctioning and weaning from ventilation. [8][9][10] More recently, a combination of modified anesthetic techniques, and advances in surgical procedures including myocardial protection and postoperative management has resulted in a marked decrease in postoperative intubation period. 11,12) Cheng, et al 13) demonstrated that early extubation could be performed safely and did not increase perioperative morbidity.…”

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confidence: 99%

Predictive Risk Factors for Pulmonary Oxygen Transfer in Patients Undergoing Coronary Artery Bypass Grafting.

et al. 2001

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SUMMARYThe ratio of arterial oxygen tension to inspired oxygen fraction (PaO 2 / FiO 2 ) is a useful indicator for weaning patients from mechanical ventilation and a reliable predictor of pulmonary dysfunction after cardiac surgery. The aim of this study was to elucidate the patient characteristics and variables that affect the PaO 2 / FiO 2 ratio.Between 1994-1998, 167 patients who underwent coronary artery bypass grafting (CABG) were examined retrospectively. Spearman's correlation coefficients were calculated between the PaO 2 / FiO 2 ratio and intubation period, and length of ICU stay. Patients were then divided into two groups with a PaO 2 / FiO 2 ratio < 350 and PaO 2 / FiO 2 ratio ≥ 350. Univariate analysis of the putative risk factors was performed. A logistic regression model was developed to evaluate factors that would influence the PaO 2 / FiO 2 ratio.A significant correlation was observed between the PaO 2 / FiO 2 ratio and intubation period, and length of ICU stay. Univariate predictors of a PaO 2 / FiO 2 ratio < 350 were low body weight, low preoperative PaO 2 , long operation time, high FiO 2 , low postoperative PaO 2 , history of smoking, hypertension and opening of pleura (p < 0.05). Excellent prediction was found with a model consisting of preoperative PaO 2 and hypertension.Conclusion: The results of this study suggest that patients with a low preoperative PaO 2 or hypertension may need more careful peri-and postoperative management since these factors are closely associated with the PaO 2 / FiO 2 ratio. (Jpn Heart J 2001; 42: 143-153)

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“…Since the middle of the 1980s, there has been a progressive change in the attitudes relating to the peroperative period of all operations from the smallest to the greatest [3,4]. This change is related to an adoption of institutional policies, primarily aiming at a reduction in the costs of procedures and maximizing the utilization of operation rooms and the beds in the intensive care and on the hospital ward.…”

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confidence: 99%

Immediate extubation in cardiac surgery: evaluation using electroencephalogram

Pinto¹,

Nunes²,

Sardenberg³

et al. 2003

Rev Bras Cir Cardiovasc

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Background and objectives: The current techniques of anesthesia employed in cardiac surgery leading to immediate extubation depend on adequate analgesia and titration of anesthetic drugs. We sought to determine the best possible moment of extubation, using the bispectral index of the electroencephalogram.Method: Twelve ASA III patients were analyzed. Seven (58.4%) were children (Group I), submitted to correction of congenital cardiac defects with ages ranging from 0 to 7 years. Five adults (Group II), with ages ranging from 30 to 75 years, underwent coronary artery bypass grafts. In Group I spinal anesthesia (L5-S1) using hyperbaric 0.5% bupivacaine (0.5mg/ kg) and morphine (5µg/kg) was chosen. In Group II epidural anesthesia (T3-T4) with catheter placement plus ropivacaine (60mg) and morphine (2mg) were employed. For the induction of anesthesia fentanila (4µg/kg), muscle relaxant and propofol (to bring the bispectral index value down to 30) were utilized. General anesthesia was maintained with sevofluorane, maintaining the bispectral index value between 40 and 60. Extubation was programmed at a bispectral index value of 90.Results: All patients were extubated up to one hour after the end of the surgical procedure, 91.6% of them in the operating room. All had the cognitive functions preserved without history of explicit memory or pain (adults and children who were able to speak), nor facial expression of pain (small children). Four (57%) patients in Group I and one (20%) in Group II had post-operative pruritus. Two patients (28%) in Group II had emesis. Conclusions:The results suggest that the technique employed is safe and effective, as long as the criteria for its use are strictly observed.Descriptors: Electro-encephalography. Anesthesia. Cardiovascular surgical procedures. Resumo: Introdução: As técnicas empregadas em cirurgia cardíaca visando a extubação imediata (EI) dependem de analgesia adequada e titulação de drogas anestésicas.Objetivo: A finalidade deste estudo é analisar a EI, utilizando eletroencefalograma (índice bispectral -BIS) para adequar o melhor momento de extubação. ORIGINAL ARTICLE 54Método: Foram analisados 12 pacientes, ASA III, 7 crianças (Grupo I) 58,4%, com idades entre 0 e 7 anos, submetidas a correção cirúrgica de cardiopatias congênitas e 5 adultos (Grupo II), com idades entre 30 e 75 anos, submetidos a revascularização do miocárdio. No Grupo I realizou-se raquianestesia entre L5 e S1 com injeção de marcaína pesada (0,5 mg/kg) e morfina (5µ µ µ µ µg/kg). No Grupo II realizou-se bloqueio epidural entre T3 e T4, com introdução de cateter e injeção de 60mg de ropivacaína e 2mg de morfina. Na indução da anestesia, empregamos: Fentanil 4 µ µ µ µ µg/kg, propofol até BIS igual a 30 e relaxante muscular. A anestesia geral foi mantida com sevoflurano para BIS entre 40 e 60. Foi programada extubação quando o BIS atingisse 90.Resultados: Todos os pacientes foram extubados até 1 hora após o término da operação, sendo 91,6% na sala de operações, com função cognitiva preservada, sem histór...

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Cardiac surgery: moving away from intensive care

Abstract: Objective

Cited by 96 publications

References 6 publications

Risk factors for prolonged ventilation after cardiac surgery using APACHE II, SAPS II, and TISS: comparison of three different models

Risk factors for prolonged ventilation after cardiac surgery using APACHE II, SAPS II, and TISS: comparison of three different models

Predictive Risk Factors for Pulmonary Oxygen Transfer in Patients Undergoing Coronary Artery Bypass Grafting.

Immediate extubation in cardiac surgery: evaluation using electroencephalogram

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