Impact of an intermediate care area on ICU utilization after cardiac surgery.

We compared utilization of a 14-bed respiratory ICU before and after establishing an intermediate care area (ICA) for patients recovering from cardiac surgery. Availability of the four-bed ICA significantly reduced the duration of ICU stay in patients who had undergone aortocoronary bypass or valvular cardiac surgery, and no potentially preventable deaths resulted from early ICU discharge. Use of an ICA should also decrease ICU utilization for other low-risk monitored patients.

Tracheomotor response to cardiopulmonary bypass: influence of lung deflation and cardiac distension.

The pressure within the water-filled cuff of an endotracheal tube (PTE) was used as a measure of tracheal smooth muscle tone in ten patients undergoing cardiopulmonary bypass (CPB). Pulmonary artery pressure (PPA) and left atrial pressure (PLA) were also monitored. Institution of CPB, with acute reduction of pulmonary blood flow and lung deflation, caused no significant change in PTE. Crystalloid cardioplegic administration without left ventricular decompression (VENT) resulted in statistically significant increases of PPA (from 1.33 +/- 0.15 to 1.88 +/- 0.2 kPa) (p less than 0.05) and of PLA (from 1.2 +/- 0.11 to 2.2 +/- 0.31 kPa) (p less than 0.05). Coincident with these changes a statistically significant increase in PTE (from 4.95 +/- 0.21 to 5.24 +/- 0.27 kPa) (p less than 0.05) was detected. This increase in PTE was significantly greater than the small random variations noted in PTE prior to cardioplegic infusion with constant PLA and PPA. Thus, minimal tracheomotor constriction in response to cardioplegia administration occurred. Larger increases in PTE were noted during cardiac compression suggesting that the water-filled cuff could have detected larger increases if they had occurred. These transient changes do not reflect clinically detectable increases in airway resistance at the termination of CPB when lung ventilation is started. Neither of these two physiological stimuli, lung deflation or cardioplegia administration, cause clinically significant increases of large airway tone during CPB.