■以重症医师为主导的心血管重症监护病房模式是心脏手术中的护理标准。这项研究检查了使用手术心脏外科医生的心血管重症监护病房模型是否,心胸外科住院医师,先进的实践提供者与可比的结果相关。
■这是对2020年至2022年由手术外科医生主导的心血管重症监护病房收治的前400名心脏手术患者的单机构审查。纳入标准是由两个心血管重症监护病房模型(主动脉手术,阀门操作,冠状动脉手术,间隔肌切除术)。来自外科医生主导的心血管重症监护病房的患者根据手术类型进行了精确匹配,并且使用包括年龄在内的逻辑回归模型,与传统心血管重症监护病房的对照组进行了1:1的倾向评分匹配。性别,术前死亡风险,切口类型,以及体外循环和循环停止的使用。主要结果是术后总住院时间。次要结果包括术后重症监护病房住院时间,30天死亡率,30天胸外科医师协会定义的发病率(永久性中风,肾功能衰竭,心脏再手术,长时间插管,深部胸骨感染),充血红细胞输注,和血管加压药的使用。两组之间的结果使用卡方比较,Fisher精确检验,或适当的2样本t检验。
■共有400名来自外科医生主导的心血管重症监护病房的患者(平均年龄61.2±12.8岁,131名女性患者[33%],346例患者[86.5%]与欧洲心脏手术风险评估系统II<2%)和他们匹配的对照组被包括在内。两个单位最常见的手术是冠状动脉旁路移植术(n=318,39.8%)和二尖瓣修复或置换(n=238,29.8%)。大约一半的手术是通过胸骨切开术进行的(n=462,57.8%)。有3例(0.2%)住院死亡,47例患者(5.9%)出现30天并发症.外科医生主导的心血管重症监护病房患者的总住院时间明显缩短(6.3天vs7.0天,P=.028),和重症监护病房住院时间呈相同方向(2.5天vs2.9天,P=.16)。重症监护病房再入院率,30天死亡率,心血管重症监护病房模型和30日发病率无显著差异.外科医生主导的心血管重症监护病房与心血管重症监护病房术后红细胞输血减少(P=.002)和血管加压药使用减少(P=.001)相关。
■在它的头两年,外科医生主导的心血管重症监护病房与传统的心血管重症监护病房具有可比性,总住院时间显着改善,心血管重症监护病房的术后输血,和血管加压药的使用。这一早期的成功证明了手术外科医生主导的心血管重症监护病房如何为接受选择性心脏手术的患者提供与标准护理模式相似的结果。
UNASSIGNED: The
intensivist-led cardiovascular intensive care unit model is the standard of care in cardiac surgery. This study examines whether a cardiovascular intensive care unit model that uses operating cardiac surgeons, cardiothoracic surgery residents, and advanced practice providers is associated with comparable outcomes.
UNASSIGNED: This is a single-institution review of the first 400 cardiac surgery patients admitted to an operating surgeon-led cardiovascular intensive care unit from 2020 to 2022. Inclusion criteria are elective status and operations managed by both cardiovascular intensive care unit models (aortic operations, valve operations, coronary operations, septal myectomy). Patients from the surgeon-led cardiovascular intensive care unit were exact matched by operation type and 1:1 propensity score matched with controls from the traditional cardiovascular intensive care unit using a logistic regression model that included age, sex, preoperative mortality risk, incision type, and use of cardiopulmonary bypass and circulatory arrest. Primary outcome was total postoperative length of stay. Secondary outcomes included postoperative intensive care unit length of stay, 30-day mortality, 30-day Society of Thoracic Surgeons-defined morbidity (permanent stroke, renal failure, cardiac reoperation, prolonged intubation, deep sternal infection), packed red cell transfusions, and vasopressor use. Outcomes between the 2 groups were compared using chi-square, Fisher exact test, or 2-sample t test as appropriate.
UNASSIGNED: A total of 400 patients from the surgeon-led cardiovascular intensive care unit (mean age 61.2 ± 12.8 years, 131 female patients [33%], 346 patients [86.5%] with European System for Cardiac Operative Risk Evaluation II <2%) and their matched controls were included. The most common operations across both units were coronary artery bypass grafting (n = 318, 39.8%) and mitral valve repair or replacement (n = 238, 29.8%). Approximately half of the operations were performed via sternotomy (n = 462, 57.8%). There were 3 (0.2%) in-hospital deaths, and 47 patients (5.9%) had a 30-day complication. The total length of stay was significantly shorter for the surgeon-led cardiovascular intensive care unit patients (6.3 vs 7.0 days, P = .028), and intensive care unit length of stay trended in the same direction (2.5 vs 2.9 days, P = .16). Intensive care unit readmission rates, 30-day mortality, and 30-day morbidity were not significantly different between cardiovascular intensive care unit models. The surgeon-led cardiovascular intensive care unit was associated with fewer postoperative red blood cell transfusions in the cardiovascular intensive care unit (P = .002) and decreased vasopressor use (P = .001).
UNASSIGNED: In its first 2 years, the surgeon-led cardiovascular intensive care unit demonstrated comparable outcomes to the traditional cardiovascular intensive care unit with significant improvements in total length of stay, postoperative transfusions in the cardiovascular intensive care unit, and vasopressor use. This early success exemplifies how an operating surgeon-led cardiovascular intensive care unit can provide similar outcomes to the standard-of-care model for patients undergoing elective cardiac surgery.