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Vol. 44. Issue 1.
Pages 27-35 (January - February 2020)
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Vol. 44. Issue 1.
Pages 27-35 (January - February 2020)
Original
DOI: 10.1016/j.medine.2018.07.018
Evaluation of two intensive care models in relation to successful extubation after cardiac surgery
Evaluación de 2 modelos de cuidados intensivos en cuanto a extubación exitosa de pacientes después de cirugía cardíaca
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G.-W. Haoa,1, G.-G. Maa,1, B.-F. Liub,1, X.-M. Yanga, D.-M. Zhua, L. Liua, Y. Zhanga, H. Liua, Y.-M. Zhuanga, Z. Luoa, G.-W. Tua,
Corresponding author
tu.guowei@zs-hospital.sh.cn

Corresponding author.
a Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, PR China
b Department of Critical Care Medicine, The First People's Hospital of Zhangjiagang, Suzhou, China
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Tables (4)
Table 1. Characteristics of patients in the two phase-groups.
Table 2. Characteristics of patients with extubation failure.
Table 3. Reasons of extubation failure.
Table 4. Characteristics of the patients with MV duration over 48h.
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Abstract
Objective

To compare outcomes between intensivist-directed and cardiac surgeon-directed care delivery models.

Design

This retrospective, historical-control study was performed in a cohort of adult cardiac surgical patients at Zhongshan Hospital (Fudan University, China). During the first phase (March to August 2015), cardiac surgeons were in charge of postoperative care while intensivists were in charge during the second phase (September 2015–June 2016). Both phases were compared regarding successful extubation rate, intensive care unit (ICU) length of stay (LOS), and in-hospital mortality.

Setting

Tertiary Zhongshan Hospital (Fudan University, China).

Patients

Consecutive adult patients admitted to the cardiac surgical ICU (CSICU) after heart surgery.

Interventions

Phase I patients treated by cardiac surgeons, and phase II patients treated by intensivists.

Main variables of interest

Successful extubation, ICU LOS and in-hospital mortality.

Results

A total of 1792 (phase I) and 3007 patients (phase II) were enrolled. Most variables did not differ significantly between the two phases. However, patients in phase II had a higher successful extubation rate (99.17% vs. 98.55%; p=0.043) and a shorter median duration of mechanical ventilation (MV) (18 vs. 19h; p<0.001). In relation to patients with MV duration >48h, those in phase II had a comparatively higher successful extubation rate (p=0.033), shorter ICU LOS (p=0.038) and a significant decrease in in-hospital mortality (p=0.039).

Conclusions

The intensivist-directed care model showed improved rates of successful extubation and shorter MV durations after cardiac surgery.

Keywords:
Extubation
Cardiac surgery
Care delivery
Mechanical ventilation
Resumen
Objetivo

Comparar el manejo entre intensivistas y cirujanos de pacientes de cirugía cardíaca en la unidad de cuidados intensivos.

Diseño

Este estudio de control retrospectivo se llevó a cabo con una cohorte de pacientes adultos de cirugía cardíaca. Durante la primera fase (de marzo a agosto de 2015), los cirujanos cardíacos estuvieron a cargo del manejo médico en la unidad; y durante la segunda fase (septiembre de 2015 a junio de 2016), lo hicieron intensivistas. Comparamos las fases en cuanto al número de extubaciones exitosas, el tiempo de estancia y la mortalidad.

Lugar del estudio

Hospital Zhongshan de la Universidad de Fudan, China.

Pacientes

Adultos admitidos secuencialmente a la unidad de cuidados intensivos cardíacos después de intervenciones quirúrgicas.

Intervenciones

Manejo médico por cirujanos en la primera fase, y por intensivistas en la segunda fase.

Variables prioritarias

Extubación exitosa, tiempo de estancia en la unidad de cuidados intensivos y mortalidad.

Resultados

Participaron 1.792 pacientes en la fase i y 3.007 en la fase ii. Los pacientes de la fase ii tuvieron más extubaciones exitosas (99,17 frente al 98,55%, p=0,043), y necesitaron menos tiempo de ventilación mecánica (mediana de 18 frente a 19h, p<0,001). De entre los pacientes con ventilación mecánica de más de 48h, los de la fase iifueron extubados exitosamente más veces, tuvieron una estancia más corta (p=0,038), y una menor mortalidad (p=0,039).

Conclusiones

El manejo médico por intensivistas aumentó significativamente el número de extubaciones exitosas y disminuyó el tiempo de ventilación mecánica.

Palabras clave:
Extubación
Cirugía cardíaca
Manejo médico
Ventilación mecánica

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