Evaluation of two intensive care models in relation to successful extubation after cardiac surgery / Evaluación de 2 modelos de cuidados intensivos en cuanto a extubación exitosa de pacientes después de cirugía cardíaca

Objective: To compare outcomes between intensivist-directed and cardiac surgeon-directed care delivery models. Design: This retrospective, historical-control study was performed in a cohort of adult cardiac surgical patients at Zhongshan Hospital (Fudan University, China). During the first phase (March to August 2015), cardiac surgeons were in charge of postoperative care while intensivists were in charge during the second phase (September 2015-June 2016). Both phases were compared regarding successful extubation rate, intensive care unit (ICU) length of stay (LOS), and in-hospital mortality. Setting: Tertiary Zhongshan Hospital (Fudan University, China). Patients: Consecutive adult patients admitted to the cardiac surgical ICU (CSICU) after heart surgery. Interventions: Phase I patients treated by cardiac surgeons, and phase II patients treated by intensivists. Main variables of interest: Successful extubation, ICU LOS and in-hospital mortality. Results: A total of 1792 (phase I) and 3007 patients (phase II) were enrolled. Most variables did not differ significantly between the two phases. However, patients in phase II had a higher successful extubation rate (99.17% vs. 98.55%; p=0.043) and a shorter median duration of mechanical ventilation (MV) (18 vs. 19h; p<0.001). In relation to patients with MV duration >48h, those in phase II had a comparatively higher successful extubation rate (p=0.033), shorter ICU LOS (p=0.038) and a significant decrease in in-hospital mortality (p=0.039). Conclusions: The intensivist-directed care model showed improved rates of successful extubation and shorter MV durations after cardiac surgery

Objetivo: Comparar el manejo entre intensivistas y cirujanos de pacientes de cirugía cardíaca en la unidad de cuidados intensivos. Diseño: Este estudio de control retrospectivo se llevó a cabo con una cohorte de pacientes adultos de cirugía cardíaca. Durante la primera fase (de marzo a agosto de 2015), los cirujanos cardíacos estuvieron a cargo del manejo médico en la unidad; y durante la segunda fase (septiembre de 2015 a junio de 2016), lo hicieron intensivistas. Comparamos las fases en cuanto al número de extubaciones exitosas, el tiempo de estancia y la mortalidad. Lugar del estudio: Hospital Zhongshan de la Universidad de Fudan, China. Pacientes: Adultos admitidos secuencialmente a la unidad de cuidados intensivos cardíacos después de intervenciones quirúrgicas. Intervenciones: Manejo médico por cirujanos en la primera fase, y por intensivistas en la segunda fase. Variables prioritarias: Extubación exitosa, tiempo de estancia en la unidad de cuidados intensivos y mortalidad. Resultados: Participaron 1.792 pacientes en la fase i y 3.007 en la fase ii. Los pacientes de la fase II tuvieron más extubaciones exitosas (99,17 frente al 98,55%, p=0,043), y necesitaron menos tiempo de ventilación mecánica (mediana de 18 frente a 19h, p<0,001). De entre los pacientes con ventilación mecánica de más de 48h, los de la fase iifueron extubados exitosamente más veces, tuvieron una estancia más corta (p=0,038), y una menor mortalidad (p=0,039). Conclusiones: El manejo médico por intensivistas aumentó significativamente el número de extubaciones exitosas y disminuyó el tiempo de ventilación mecánica

Evaluation of two intensive care models in relation to successful extubation after cardiac surgery.

OBJECTIVE: To compare outcomes between intensivist-directed and cardiac surgeon-directed care delivery models. DESIGN: This retrospective, historical-control study was performed in a cohort of adult cardiac surgical patients at Zhongshan Hospital (Fudan University, China). During the first phase (March to August 2015), cardiac surgeons were in charge of postoperative care while intensivists were in charge during the second phase (September 2015-June 2016). Both phases were compared regarding successful extubation rate, intensive care unit (ICU) length of stay (LOS), and in-hospital mortality. SETTING: Tertiary Zhongshan Hospital (Fudan University, China). PATIENTS: Consecutive adult patients admitted to the cardiac surgical ICU (CSICU) after heart surgery. INTERVENTIONS: Phase I patients treated by cardiac surgeons, and phase II patients treated by intensivists. MAIN VARIABLES OF INTEREST: Successful extubation, ICU LOS and in-hospital mortality. RESULTS: A total of 1792 (phase I) and 3007 patients (phase II) were enrolled. Most variables did not differ significantly between the two phases. However, patients in phase II had a higher successful extubation rate (99.17% vs. 98.55%; p=0.043) and a shorter median duration of mechanical ventilation (MV) (18 vs. 19h; p<0.001). In relation to patients with MV duration >48h, those in phase II had a comparatively higher successful extubation rate (p=0.033), shorter ICU LOS (p=0.038) and a significant decrease in in-hospital mortality (p=0.039). CONCLUSIONS: The intensivist-directed care model showed improved rates of successful extubation and shorter MV durations after cardiac surgery.