Day 0 intensive care unit discharge — risk or benefit for the patient who undergoes myocardial revascularization?

Calafiore, Antonio M.; Scipioni, G; Teodori, Giovanni; Giammarco, Gabriele Di; Mauro, Michele Di; Canosa, Carlo; Iacò, Angela L.; Vitolla, Giuseppe

doi:10.1016/s1010-7940(01)01151-4

Cited by 15 publications

(11 citation statements)

References 13 publications

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“…Studies have confirmed that any reduction in ICU length of stay produces significant cost savings and improves resource utilization [39,40]. This is particularly true for liver transplantation in which even a small reduction in ICU length of stay accrues significant savings [41].…”

Section: Cost Saving and Immediate Postoperative Extubationmentioning

confidence: 88%

The clinical value of early extubation

Mandell¹,

Campsen

Zimmerman

et al. 2009

Current Opinion in Organ Transplantation

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There is robust evidence to support the use of immediate postoperative ventilation in liver transplant recipients. There is no evidence, however, to show that routine ventilation of all transplant recipients provides outcomes that are as good as those documented in extubated patients. It is probably time to turn the evidentiary tables around and ask proponents of routine ventilation to prove that they have done no harm and that they meet the new minimal performance standards established by immediate postoperative extubation.

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Section: Cost Saving and Immediate Postoperative Extubationmentioning

confidence: 88%

The clinical value of early extubation

Mandell¹,

Campsen

Zimmerman

et al. 2009

Current Opinion in Organ Transplantation

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“…But only by shortening the period of prolonged ventilatory support could the monitoring times also be consecutively shortened in the ICU [21,27]. While a study of Kogan [21] defines the postoperative transfer of patients from the ICU on the 1 st postoperative day as a fast-track population, in an article of Calafiore the patients of the fast-track population [20] were already transferred from the intensive care unit on the day of surgery. Since the fast-track concept has many facets, usually only a very limited comparison of published studies on the fast-track topic is possible.…”

Section: Discussionmentioning

confidence: 99%

“…This requires efficient surgical planning, as well as a meticulous preoperative assessment of the patient population [1-4,13-22]. Besides shortening ICU occupancy times, which is undisputedly the limiting factor and the bottleneck in the care of heart surgery patients, the rising costs can be contained by shortening the overall hospitalisation period [16,19,20]. The precondition for introducing fast-track concepts was the continuous further development of existing surgical, cardiac technological, anesthesiological and postoperative management [1-4,7,13,23-25].…”

Section: Introductionmentioning

confidence: 99%

“…The introduction of short-acting substances such as propofol or remifentanil as well as inhalation anesthetics such as sevoflurane has contributed decisively to changing monitored anesthesia care. Calafiore [20] describes an increase in patient flow of about 15% in the ICU after the introduction of a fast-track concept without a negative impact on the quality of patient care, expressed as the incidence of postoperative morbidity or mortality. A further point is the fact that the number of postponed or cancelled operations decreases drastically due to the optimised use of limited intensive care capacities through fast-track programs.…”

Section: Introductionmentioning

confidence: 99%

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Risk factor analysis for fast track protocol failure

Kiessling

Huneke

Reyher

et al. 2013

J Cardiothorac Surg

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BackgroundThe introduction of fast-track treatment procedures following cardiac surgery has significantly shortened hospitalisation times in intensive care units (ICU). Readmission to intensive care units is generally considered a negative quality criterion. The aim of this retrospective study is to statistically analyse risk factors and predictors for re-admission to the ICU after a fast-track patient management program.Methods229 operated patients (67 ± 11 years, 75% male, BMI 27 ± 3, 6/2010-5/2011) with use of extracorporeal circulation (70 ± 31 min aortic crossclamping, CABG 62%) were selected for a preoperative fast-track procedure (transfer on the day of surgery to an intermediate care (IMC) unit, stable circulatory conditions, extubated). A uni- and multivariate analysis were performed to identify independent predictors for re-admission to the ICU.ResultsOver the 11-month study period, 36% of all preoperatively declared fast-track patients could not be transferred to an IMC unit on the day of surgery (n = 77) or had to be readmitted to the ICU after the first postoperative day (n = 4). Readmission or ICU stay signifies a dramatic worsening of the patient outcome (mortality 0/10%, mean hospital stay 10.3 ± 2.5/16.5 ± 16.3, mean transfusion rate 1.4 ± 1,7/5.3 ± 9.1). Predicators for failure of the fast-track procedure are a preoperative ASA class > 3, NYHA class > III and an operation time >267 min ± 74. The significant risk factors for a major postoperative event (= low cardiac output and/or mortality and/or renal failure and/or re-thoracotomy and/or septic shock and/or wound healing disturbances and/or stroke) are a poor EF (OR 2.7 CI 95% 0.98-7.6) and the described ICU readmission (OR 0.14 CI95% 0.05-0.36).ConclusionRe-admission to the ICU or failure to transfer patients to the IMC is associated with a high loss of patient outcome. The ASA > 3, NYHA class > 3 and operation time >267 minutes are independent predictors of fast track protocol failure.

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“…There is an increasing trend for physicians to extubate patients immediately following major surgery to facilitate early discharge from or avoid admission to the intensive care unit 1. This practice is primarily driven by the need to reduce cost and improve resource utilization by eliminating unnecessary medical interventions and care 2, 3. Large and multiinstitutional randomized controlled studies confirm that extubation of patients within 8 hours after cardiac surgery reduces cost by decreasing intensive care unit and hospital length of stay 1–4.…”

mentioning

confidence: 99%

A multicenter evaluation of safety of early extubation in liver transplant recipients

et al. 2007

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Small single-institutional studies performed prior to the introduction of organ allocation using the Model for End-Stage Liver Disease (MELD) suggest that early airway extubation of liver transplant recipients is a safe practice. We designed a multicenter study to examine adverse events associated with early extubation in patients selected for liver transplantation using MELD score. A total of 7 institutions extubated all patients meeting study criteria and reported adverse events that occurred within 72 hours following surgery. Adverse events were uncommon: occurring in only 7.7% of 391 patients studied. Most adverse events were pulmonary or surgically related. Pulmonary complications were usually minor, requiring only an increase in ambient oxygen concentration. The majority of surgical adverse events required additional surgery. Analysis of a limited set of perioperative variables suggest that blood transfusions and technical factors were associated with an increased risk of adverse events. In conclusion, while early extubation appears to be safe under specified circumstances, there are performance differences between institutions that remain to be explained. Liver Transpl 13:1557Transpl 13: -1563Transpl 13: , 2007

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Day 0 intensive care unit discharge — risk or benefit for the patient who undergoes myocardial revascularization?

Abstract: Day 0 ICU discharge can be obtained in selected patients without an increased risk of death or of ICU readmission. The impact in terms of resource saving is striking.

Cited by 15 publications

References 13 publications

The clinical value of early extubation

The clinical value of early extubation

Risk factor analysis for fast track protocol failure

A multicenter evaluation of safety of early extubation in liver transplant recipients

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