Intermediate Care Unit After Cardiac Surgery: Impact on Length of Stay and Outcomes

Labata, Carlos; Oliveras, Teresa; Berastegui, Elisabet; Ruyra, Xavier; Romero, Bernardo Prida; Cámara, María-Luisa; Just, M.; Serra, Jordi; Rueda, Ferran; Ferrer, Marc; García-García, Cosme; Bayés‐Genís, Antoni

doi:10.1016/j.rec.2017.10.018

Cited by 5 publications

(7 citation statements)

References 31 publications

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“…Therefore, the participants in this study understand the importance of providing qualified care to patients after heart surgery to detect such complications early. In this sense, their speeches corroborate the thought that the nursing team should provide quality assistance based on technical-scientific knowledge, thus considering the patient's complexity and fast decision-making in clinical and surgical complications (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) .…”

Section: Discussionmentioning

confidence: 62%

“…The first critical node discussed in this category is the care/ handling of pleural and/or mediastinal drains. Observing the output of thoracic drains is mandatory in the postoperative heart surgery period to assess whether there is excessive bleeding or blood accumulated in the mediastinal or pleural cavities (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) . Regarding the drainage volume, excessive bleeding is drainage greater than 3 ml/kg / h in the first three postoperative hours and more than 1.5 ml/ kg/h after this period (22) .…”

Section: Discussionmentioning

confidence: 99%

“…The performance of surgeries of this size requires that the immediate postoperative care (24 hours after surgery) and part of the mediate (after 24 hours after surgery) be performed in the Intensive Care Unit (ICU), as the intensive care provided in this period is related to the surgical success and adequate patient recovery (3)(4) . Such assistance requires specific care, such as preserving hemodynamic stability, bleeding monitoring, assessing breathing patterns, recording fluid intake and elimination, and draining flow, among others (5)(6) .…”

Section: Introductionmentioning

confidence: 99%

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Nursing care for patient in post operatory heart surgery in the Intensive Care Unit

2021

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Objective: To investigate the critical nodes related to nursing care for patients in the postoperative period of cardiac surgery. Methods: Exploratory study with a qualitative approach. Data collected through semi-structured interviews with 27 members of the nursing team working in the Intensive Care Unit. Material submitted to thematic analysis. Results: Three categories emerged: Flaws in the professional qualification for patient care in the postoperative period of cardiac surgery; Team challenges concerning specific patient care in the postoperative period of cardiac surgery; and (dis) organization of work in the Intensive Care Unit and its impact on nursing care for patients in the postoperative period of cardiac surgery. Final considerations: Given the identification of the critical nodes, the professionals presented suggestions to overcome daily difficulties: investments in strategies for Permanent Education in Health; creation of tools to guide patient assistance in the postoperative of cardiac surgery; and provision of adequate human resources.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Nursing care for patient in post operatory heart surgery in the Intensive Care Unit

2021

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“…32 The relationship between the IMCU and CICU has not been studied, but IMCUs have been shown to improve outcomes in postcardiac surgery patients. 33 Although our institution does not have an IMCU, the M-CARS could, theoretically, apply to the decision between admission to CICUs and IMCUs in institutions with this option.…”

Section: Discussionmentioning

confidence: 99%

The Mayo Cardiac Intensive Care Unit Admission Risk Score is Associated with Medical Resource Utilization During Hospitalization

Breen

Bennett

Diepen

et al. 2021

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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Objective: To determine whether the Mayo Cardiac Intensive Care Unit (CICU) Admission Risk Score (M-CARS) is associated with CICU resource utilization. Patients and Methods: Adult patients admitted to our CICU from 2007 to 2018 were retrospectively reviewed, and M-CARS was calculated from admission data. Groups were compared using Wilcoxon test for continuous variables and c 2 test for categorical variables. Results: We included 12,428 patients with a mean age of 67AE15 years (37% female patients). The mean M-CARS was 2.1AE2.1, including 5890 (47.4%) patients with M-CARS less than 2 and 644 (5.2%) patients with M-CARS greater than 6. Critical care restricted therapies were frequently used, including mechanical ventilation in 28.0%, vasoactive medications in 25.5%, and dialysis in 4.8%. A higher M-CARS was associated with greater use of critical-care therapies and longer CICU and hospital length of stay. The lowrisk cohort with M-CARS less than 2 was less likely to require critical-careerestricted therapies, including invasive or noninvasive mechanical ventilation (8.0% vs 46.1%), vasoactive medications (10.1% vs 38.8%), or dialysis (1.0% vs 8.2%), compared with patients with M-CARS greater than or equal to 2 (all P<.001). Conclusion:Patients with M-CARS less than 2 infrequently require critical-care resources and have extremely low mortality, suggesting that the M-CARS could be used to facilitate the triage of critically ill cardiac patients.

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“…Patients are generally downgraded to SDU care from the CCS and readmissions to the CCS unit can be made from the SDU or from general units following clinical indication. This combination of advanced care services has been shown to be effective in terms of resource allocation as well as improving patient outcomes [6].…”

Section: Discussionmentioning

confidence: 99%

The Use of Critical Care Services After Orthopedic Surgery at a High-Volume Orthopedic Medical Center: A Retrospective Study

et al. 2021

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Background: With an aging population, orthopedics has become one of the largest and fastest growing surgical fields. However, data on the use of critical care services (CCS) in patients undergoing orthopedic procedures remain sparse. Purpose: We sought to elucidate the prevalence and characteristics of patients requiring CCS and intermediate levels of care after orthopedic surgeries at a high-volume orthopedic medical center. Methods: We retrospectively reviewed inpatient electronic medical record data (2016–2020) at a high-volume orthopedic hospital. Patients who required CCS and intermediate levels of care, including step-down unit (SDU) and telemetry services, were identified. We described characteristics related to patients, procedures, and outcomes, including type of advanced services required and surgery type. Results: Of the 50,387 patients who underwent orthopedic inpatient surgery, 1.6% required CCS and 21.6% were admitted to an SDU. Additionally, 482 (1.0%) patients required postoperative mechanical ventilation and 3602 (7.1%) patients required continuous positive airway pressure therapy. Spine surgery patients were the most likely to require any form of advanced care (45.7%). Conclusions: This retrospective review found that approximately one-fourth of orthopedic surgery patients were admitted to units that provided critical and intermediate levels of care. These results may prove useful to hospitals in estimating needs and allocating resources for advanced and critical care services after orthopedic surgery.

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Intermediate Care Unit After Cardiac Surgery: Impact on Length of Stay and Outcomes

Cited by 5 publications

References 31 publications

Nursing care for patient in post operatory heart surgery in the Intensive Care Unit

Nursing care for patient in post operatory heart surgery in the Intensive Care Unit

The Mayo Cardiac Intensive Care Unit Admission Risk Score is Associated with Medical Resource Utilization During Hospitalization

The Use of Critical Care Services After Orthopedic Surgery at a High-Volume Orthopedic Medical Center: A Retrospective Study

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