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A specialized post-anaesthetic care unit improves fast-track management in cardiac surgery: a prospective randomized trial
INTRODUCTION: Fast-track treatment in cardiac surgery has become the global standard of care. We compared the efficacy and safety of a specialised post-anaesthetic care unit (PACU) to a conventional intensive care unit (ICU) in achieving defined fast-track end points in adult patients after elective...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4243831/ https://www.ncbi.nlm.nih.gov/pubmed/25123092 http://dx.doi.org/10.1186/s13054-014-0468-2 |
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author | Probst, Stefan Cech, Christof Haentschel, Dirk Scholz, Markus Ender, Joerg |
author_facet | Probst, Stefan Cech, Christof Haentschel, Dirk Scholz, Markus Ender, Joerg |
author_sort | Probst, Stefan |
collection | PubMed |
description | INTRODUCTION: Fast-track treatment in cardiac surgery has become the global standard of care. We compared the efficacy and safety of a specialised post-anaesthetic care unit (PACU) to a conventional intensive care unit (ICU) in achieving defined fast-track end points in adult patients after elective cardiac surgery. METHODS: In a prospective, single-blinded, randomized study, 200 adult patients undergoing elective cardiac surgery (coronary artery bypass graft (CABG), valve surgery or combined CABG and valve surgery), were selected to receive their postoperative treatment either in the ICU (n = 100), or in the PACU (n = 100). Patients who, at the time of surgery, were in cardiogenic shock, required renal dialysis, or had an additive EuroSCORE of more than 10 were excluded from the study. The primary end points were: time to extubation (ET), and length of stay in the PACU or ICU (PACU/ICU LOS respectively). Secondary end points analysed were the incidences of: surgical re-exploration, development of haemothorax, new-onset cardiac arrhythmia, low cardiac output syndrome, need for cardiopulmonary resuscitation, stroke, acute renal failure, and death. RESULTS: Median time to extubation was 90 [50; 140] min in the PACU vs. 478 [305; 643] min in the ICU group (P <0.001). Median length of stay in the PACU was 3.3 [2.7; 4.0] hours vs. 17.9 [10.3; 24.9] hours in the ICU (P <0.001). Of the adverse events examined, only the incidence of new-onset cardiac arrhythmia (25 in PACU vs. 41 in ICU, P = 0.02) was statistically different between groups. CONCLUSIONS: Treatment in a specialised PACU rather than an ICU, after elective cardiac surgery leads to earlier extubation and quicker discharge to a step-down unit, without compromising patient safety. TRIAL REGISTRATION: ISRCTN71768341. Registered 11 March 2014. |
format | Online Article Text |
id | pubmed-4243831 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-42438312014-11-26 A specialized post-anaesthetic care unit improves fast-track management in cardiac surgery: a prospective randomized trial Probst, Stefan Cech, Christof Haentschel, Dirk Scholz, Markus Ender, Joerg Crit Care Research INTRODUCTION: Fast-track treatment in cardiac surgery has become the global standard of care. We compared the efficacy and safety of a specialised post-anaesthetic care unit (PACU) to a conventional intensive care unit (ICU) in achieving defined fast-track end points in adult patients after elective cardiac surgery. METHODS: In a prospective, single-blinded, randomized study, 200 adult patients undergoing elective cardiac surgery (coronary artery bypass graft (CABG), valve surgery or combined CABG and valve surgery), were selected to receive their postoperative treatment either in the ICU (n = 100), or in the PACU (n = 100). Patients who, at the time of surgery, were in cardiogenic shock, required renal dialysis, or had an additive EuroSCORE of more than 10 were excluded from the study. The primary end points were: time to extubation (ET), and length of stay in the PACU or ICU (PACU/ICU LOS respectively). Secondary end points analysed were the incidences of: surgical re-exploration, development of haemothorax, new-onset cardiac arrhythmia, low cardiac output syndrome, need for cardiopulmonary resuscitation, stroke, acute renal failure, and death. RESULTS: Median time to extubation was 90 [50; 140] min in the PACU vs. 478 [305; 643] min in the ICU group (P <0.001). Median length of stay in the PACU was 3.3 [2.7; 4.0] hours vs. 17.9 [10.3; 24.9] hours in the ICU (P <0.001). Of the adverse events examined, only the incidence of new-onset cardiac arrhythmia (25 in PACU vs. 41 in ICU, P = 0.02) was statistically different between groups. CONCLUSIONS: Treatment in a specialised PACU rather than an ICU, after elective cardiac surgery leads to earlier extubation and quicker discharge to a step-down unit, without compromising patient safety. TRIAL REGISTRATION: ISRCTN71768341. Registered 11 March 2014. BioMed Central 2014-08-15 2014 /pmc/articles/PMC4243831/ /pubmed/25123092 http://dx.doi.org/10.1186/s13054-014-0468-2 Text en © Probst et al., licensee BioMed Central Ltd. 2014 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Probst, Stefan Cech, Christof Haentschel, Dirk Scholz, Markus Ender, Joerg A specialized post-anaesthetic care unit improves fast-track management in cardiac surgery: a prospective randomized trial |
title | A specialized post-anaesthetic care unit improves fast-track management in cardiac surgery: a prospective randomized trial |
title_full | A specialized post-anaesthetic care unit improves fast-track management in cardiac surgery: a prospective randomized trial |
title_fullStr | A specialized post-anaesthetic care unit improves fast-track management in cardiac surgery: a prospective randomized trial |
title_full_unstemmed | A specialized post-anaesthetic care unit improves fast-track management in cardiac surgery: a prospective randomized trial |
title_short | A specialized post-anaesthetic care unit improves fast-track management in cardiac surgery: a prospective randomized trial |
title_sort | specialized post-anaesthetic care unit improves fast-track management in cardiac surgery: a prospective randomized trial |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4243831/ https://www.ncbi.nlm.nih.gov/pubmed/25123092 http://dx.doi.org/10.1186/s13054-014-0468-2 |
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