Cargando…

The Impact of an Attending Intensivist on the Clinical Outcomes of Patients Admitted to the Cardiac Surgical Intensive Care Unit after Coronary Artery Bypass Grafting

BACKGROUND: We aimed to investigate the associations of critical care provided in a cardiac surgical intensive care unit (CSICU) staffed by an attending intensivist with improvements in intensive care unit (ICU) quality and reductions in postoperative complications. METHODS: Patients who underwent e...

Descripción completa

Detalles Bibliográficos
Autores principales: Kim, Dong Jung, Sohn, Bongyeon, Kim, Hakju, Chang, Hyoung Woo, Lee, Jae Hang, Kim, Jun Sung, Lim, Cheong, Park, Kay-Hyun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Society for Thoracic and Cardiovascular Surgery 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7006613/
https://www.ncbi.nlm.nih.gov/pubmed/32090052
http://dx.doi.org/10.5090/kjtcs.2020.53.1.8
_version_ 1783495183970598912
author Kim, Dong Jung
Sohn, Bongyeon
Kim, Hakju
Chang, Hyoung Woo
Lee, Jae Hang
Kim, Jun Sung
Lim, Cheong
Park, Kay-Hyun
author_facet Kim, Dong Jung
Sohn, Bongyeon
Kim, Hakju
Chang, Hyoung Woo
Lee, Jae Hang
Kim, Jun Sung
Lim, Cheong
Park, Kay-Hyun
author_sort Kim, Dong Jung
collection PubMed
description BACKGROUND: We aimed to investigate the associations of critical care provided in a cardiac surgical intensive care unit (CSICU) staffed by an attending intensivist with improvements in intensive care unit (ICU) quality and reductions in postoperative complications. METHODS: Patients who underwent elective isolated coronary artery bypass grafting (CABG) between January 2007 and December 2012 (the control group) were propensity-matched (1:1) to CABG patients between January 2013 and June 2018 (the intensivist group). RESULTS: Using propensity score matching, 302 patients were extracted from each group. The proportion of patients with at least 1 postoperative complication was significantly lower in the intensivist group than in the control group (17.2% vs. 28.5%, p=0.001). In the intensivist group, the duration of mechanical ventilation (6.4±13.7 hours vs. 13.7±49.3 hours, p=0.013) and length of ICU stay (28.7±33.9 hours vs. 41.7±90.4 hours, p=0.018) were significantly shorter than in the control group. The proportions of patients with prolonged mechanical ventilation (2.3% vs. 7.6%, p=0.006), delirium (1.3% vs. 6.3%, p=0.003) and acute kidney injury (1.3% vs. 5.3%, p=0.012) were significantly lower in the intensivist group than in the control group. CONCLUSION: A transition from an open ICU model with trainee coverage to a closed ICU model with attending intensivist coverage can be expected to yield improvements in CSICU quality and reductions in postoperative complications.
format Online
Article
Text
id pubmed-7006613
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher The Korean Society for Thoracic and Cardiovascular Surgery
record_format MEDLINE/PubMed
spelling pubmed-70066132020-02-21 The Impact of an Attending Intensivist on the Clinical Outcomes of Patients Admitted to the Cardiac Surgical Intensive Care Unit after Coronary Artery Bypass Grafting Kim, Dong Jung Sohn, Bongyeon Kim, Hakju Chang, Hyoung Woo Lee, Jae Hang Kim, Jun Sung Lim, Cheong Park, Kay-Hyun Korean J Thorac Cardiovasc Surg Clinical Research BACKGROUND: We aimed to investigate the associations of critical care provided in a cardiac surgical intensive care unit (CSICU) staffed by an attending intensivist with improvements in intensive care unit (ICU) quality and reductions in postoperative complications. METHODS: Patients who underwent elective isolated coronary artery bypass grafting (CABG) between January 2007 and December 2012 (the control group) were propensity-matched (1:1) to CABG patients between January 2013 and June 2018 (the intensivist group). RESULTS: Using propensity score matching, 302 patients were extracted from each group. The proportion of patients with at least 1 postoperative complication was significantly lower in the intensivist group than in the control group (17.2% vs. 28.5%, p=0.001). In the intensivist group, the duration of mechanical ventilation (6.4±13.7 hours vs. 13.7±49.3 hours, p=0.013) and length of ICU stay (28.7±33.9 hours vs. 41.7±90.4 hours, p=0.018) were significantly shorter than in the control group. The proportions of patients with prolonged mechanical ventilation (2.3% vs. 7.6%, p=0.006), delirium (1.3% vs. 6.3%, p=0.003) and acute kidney injury (1.3% vs. 5.3%, p=0.012) were significantly lower in the intensivist group than in the control group. CONCLUSION: A transition from an open ICU model with trainee coverage to a closed ICU model with attending intensivist coverage can be expected to yield improvements in CSICU quality and reductions in postoperative complications. The Korean Society for Thoracic and Cardiovascular Surgery 2020-02 2020-02-05 /pmc/articles/PMC7006613/ /pubmed/32090052 http://dx.doi.org/10.5090/kjtcs.2020.53.1.8 Text en Copyright © 2020 by The Korean Society for Thoracic and Cardiovascular Surgery. All rights Reserved. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Research
Kim, Dong Jung
Sohn, Bongyeon
Kim, Hakju
Chang, Hyoung Woo
Lee, Jae Hang
Kim, Jun Sung
Lim, Cheong
Park, Kay-Hyun
The Impact of an Attending Intensivist on the Clinical Outcomes of Patients Admitted to the Cardiac Surgical Intensive Care Unit after Coronary Artery Bypass Grafting
title The Impact of an Attending Intensivist on the Clinical Outcomes of Patients Admitted to the Cardiac Surgical Intensive Care Unit after Coronary Artery Bypass Grafting
title_full The Impact of an Attending Intensivist on the Clinical Outcomes of Patients Admitted to the Cardiac Surgical Intensive Care Unit after Coronary Artery Bypass Grafting
title_fullStr The Impact of an Attending Intensivist on the Clinical Outcomes of Patients Admitted to the Cardiac Surgical Intensive Care Unit after Coronary Artery Bypass Grafting
title_full_unstemmed The Impact of an Attending Intensivist on the Clinical Outcomes of Patients Admitted to the Cardiac Surgical Intensive Care Unit after Coronary Artery Bypass Grafting
title_short The Impact of an Attending Intensivist on the Clinical Outcomes of Patients Admitted to the Cardiac Surgical Intensive Care Unit after Coronary Artery Bypass Grafting
title_sort impact of an attending intensivist on the clinical outcomes of patients admitted to the cardiac surgical intensive care unit after coronary artery bypass grafting
topic Clinical Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7006613/
https://www.ncbi.nlm.nih.gov/pubmed/32090052
http://dx.doi.org/10.5090/kjtcs.2020.53.1.8
work_keys_str_mv AT kimdongjung theimpactofanattendingintensivistontheclinicaloutcomesofpatientsadmittedtothecardiacsurgicalintensivecareunitaftercoronaryarterybypassgrafting
AT sohnbongyeon theimpactofanattendingintensivistontheclinicaloutcomesofpatientsadmittedtothecardiacsurgicalintensivecareunitaftercoronaryarterybypassgrafting
AT kimhakju theimpactofanattendingintensivistontheclinicaloutcomesofpatientsadmittedtothecardiacsurgicalintensivecareunitaftercoronaryarterybypassgrafting
AT changhyoungwoo theimpactofanattendingintensivistontheclinicaloutcomesofpatientsadmittedtothecardiacsurgicalintensivecareunitaftercoronaryarterybypassgrafting
AT leejaehang theimpactofanattendingintensivistontheclinicaloutcomesofpatientsadmittedtothecardiacsurgicalintensivecareunitaftercoronaryarterybypassgrafting
AT kimjunsung theimpactofanattendingintensivistontheclinicaloutcomesofpatientsadmittedtothecardiacsurgicalintensivecareunitaftercoronaryarterybypassgrafting
AT limcheong theimpactofanattendingintensivistontheclinicaloutcomesofpatientsadmittedtothecardiacsurgicalintensivecareunitaftercoronaryarterybypassgrafting
AT parkkayhyun theimpactofanattendingintensivistontheclinicaloutcomesofpatientsadmittedtothecardiacsurgicalintensivecareunitaftercoronaryarterybypassgrafting
AT kimdongjung impactofanattendingintensivistontheclinicaloutcomesofpatientsadmittedtothecardiacsurgicalintensivecareunitaftercoronaryarterybypassgrafting
AT sohnbongyeon impactofanattendingintensivistontheclinicaloutcomesofpatientsadmittedtothecardiacsurgicalintensivecareunitaftercoronaryarterybypassgrafting
AT kimhakju impactofanattendingintensivistontheclinicaloutcomesofpatientsadmittedtothecardiacsurgicalintensivecareunitaftercoronaryarterybypassgrafting
AT changhyoungwoo impactofanattendingintensivistontheclinicaloutcomesofpatientsadmittedtothecardiacsurgicalintensivecareunitaftercoronaryarterybypassgrafting
AT leejaehang impactofanattendingintensivistontheclinicaloutcomesofpatientsadmittedtothecardiacsurgicalintensivecareunitaftercoronaryarterybypassgrafting
AT kimjunsung impactofanattendingintensivistontheclinicaloutcomesofpatientsadmittedtothecardiacsurgicalintensivecareunitaftercoronaryarterybypassgrafting
AT limcheong impactofanattendingintensivistontheclinicaloutcomesofpatientsadmittedtothecardiacsurgicalintensivecareunitaftercoronaryarterybypassgrafting
AT parkkayhyun impactofanattendingintensivistontheclinicaloutcomesofpatientsadmittedtothecardiacsurgicalintensivecareunitaftercoronaryarterybypassgrafting