Dedicated pediatric cardiac intensive care unit in a developing country: Does it improve the outcome?

Abstract

Introduction and Aim:Focussed cardiac intensive care is known to produce better outcomes. We have evaluated the benefits of a dedicated Pediatric Cardiac Intensive Care Unit (PCICU) in the early postoperative outcomes of patients undergoing surgery for congenital heart disease.Methods:Prospectively collected data of 634 consecutive patients who underwent congenital heart surgery from September 2008 to September 2009 were analyzed. Midway through this period a dedicated PCICU was started. The patients who were treated in this new PCICU formed the study group (Group B, n = 318). The patients who were treated in a common postoperative cardiac surgery ICU formed the control group (Group A, n = 316). Early postoperative outcomes between the two groups were compared.Results:The two groups were comparable with respect to demographic data and intraoperative variables. The duration of mechanical ventilation in the dedicated pediatric cardiac ICU group (32.22 ± 52.02 hours) was lower when compared with the combined adult and pediatric surgery ICU group (42.92 ± 74.24 hours, P= 0.04). There was a shorter duration of ICU stay in the dedicated pediatric cardiac ICU group (2.69 ± 2.9 days vs. 3.43 ± 3.80 days, P = 0.001). The study group also showed a shorter duration of inotropic support and duration of invasive lines. The incidence of blood stream infections was also lower in the dedicated pediatric ICU group (5.03 vs. 9.18%, P = 0.04). A subgroup analysis of neonates and infants <1 year showed that the advantages of a dedicated pediatric intensive care unit were more pronounced in this group of patients.Conclusions:Establishment of a dedicated pediatric cardiac intensive care unit has shown better outcomes in terms of earlier extubation, de-intensification, and discharge from the ICU. Blood stream infections were also reduced.

An Impact Evaluation of a Newly Developed Pediatric Cardiac Intensive Care Unit

“…They agree with the AHA's statement regarding physical location of these patients within organizational systems and state ''the real issue relates to the ability of the organizational model (whatever form it may take) to provide 'team care' based on delivery of 'integrated multidisciplinary care of critically ill patients.''' 12 Another small, single-institution retrospective review conducted in 2011 by Balachandran and colleagues 13 in India resulted in better mortality and morbidity outcomes. This meta-analysis analyzed the care of stroke patients provided in specialized stroke units.…”

International Telemedicine in Pediatric Cardiac Critical Care: A Multicenter Experience

“…Scarcity of dedicated cardiac intensive care units (CICUs) with specialized medical staff is a widespread problem in developing countries with the pressing need to advance their level of expertise in the management of complex congenital heart disease. 1,2 Telemedicine is a relatively new tool, emerging as a valuable alternative to alleviate these deficiencies, providing expedited access to the opinions of qualified specialists from high-performance centers, and enabling education.…”

Low free triiodothyronine levels in mexican pediatric population with congenital heart disease after cardiac surgery undergoing cardiopulmonary bypass.

“…Continuous improvement in cardiopulmonary bypass techniques has been essential to in the performance of surgical procedures, and therefore to operate previously considered inoperable malformation; [10][11][12] however, some it complications are inevitable, mostly due to the exposure of blood to the plastic (non-endothelized) tubing used in CPB; to the shearing forces sustained by the blood and to some surgical techniques such as hypothermia and hypothermic circulatory arrest, which cause severe blood, tissue and other vital organs damage.…”