Objective: To describe changes in ICU postoperative
management strategies utilized for patients undergoing cardiac surgery.
The treatment of these patients serves as a useful illustration of the
changing patterns of ICU utilization and care associated with
Design: Evidence-based review of
the clinical literature following a MEDLINE search, direct observation
of rapid recovery programs following surgery, and informal inquiry of
others utilizing similar approaches to postoperative cardiac surgery
Setting and patients: The reports reviewed are
from a diverse set of hospitals providing cardiac surgery services in
both Europe and the United States. Most reports focus efforts on
patients undergoing coronary artery revascularization.
Measurements: Outcome measures used to gauge the
effectiveness of postoperative ICU care typically include time to
extubation, ICU and hospital length of stay, postoperative
complications including reintubation and ICU readmission, patient
satisfaction, and health resource savings.
results: The literature regarding current practice for
postoperative ICU management in cardiac surgery consists primarily of
grade 2 and 3 literature.
Conclusions: Despite the
paucity of controlled data, rapid recovery, extubation, and discharge
from the ICU following cardiac surgery is an approach to care that is
growing in acceptance. The goals include reduction in the utilization
of resources and costs associated with cardiac surgery and maintenance
of quality of care and patient satisfaction. Assessment of outcomes
requires a program to monitor outcomes. Success does not appear to be
linked to preoperative risk for most patients but does relate directly
to the anesthetic management delivered in the operating room. Few
adverse consequences from this approach have been reported. Experience
to date suggests that programs designed to truncate ICU admission
following cardiac surgery can be implemented with the cooperation
between the health delivery team including surgeon, anesthesiologist,
intensivist where available, nursing, respiratory care, and patient and
family. These programs can serve as useful models for reassessing the
utilization and role of the ICU in the postoperative treatment of
routine surgical patients.