Predictors of Intensive Care Unit Admission in Patients Undergoing Lead Extraction: A 10-Year Observational Study in a High-Volume Center.

Autor: Monaco F; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy., Di Tomasso N; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy., Landoni G; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy. Electronic address: landoni.giovanni@hsr.it., Nardelli P; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy., Radinovic A; Unit of Arrhythmology and Electrophysiology, IRCCS San Raffaele Scientific Institute, Milan, Italy., Melillo F; Unit of Arrhythmology and Electrophysiology, IRCCS San Raffaele Scientific Institute, Milan, Italy., D'Angelo G; Unit of Arrhythmology and Electrophysiology, IRCCS San Raffaele Scientific Institute, Milan, Italy., Della Bella P; Vita-Salute San Raffaele University, Milan, Italy; Unit of Arrhythmology and Electrophysiology, IRCCS San Raffaele Scientific Institute, Milan, Italy., Zangrillo A; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy., Mazzone P; Unit of Arrhythmology and Electrophysiology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Jazyk: angličtina
Zdroj: Journal of cardiothoracic and vascular anesthesia [J Cardiothorac Vasc Anesth] 2019 Jul; Vol. 33 (7), pp. 1845-1851. Date of Electronic Publication: 2019 Feb 13.
DOI: 10.1053/j.jvca.2019.02.012
Abstrakt: Objective: To identify reliable predictors of periprocedural intensive care unit (ICU) admission after transvenous lead extraction (LE) in a high-volume center.
Design: Retrospective observational study.
Setting: University tertiary-care hospital.
Participants: All patients undergoing LE at San Raffaele Scientific Institute, Milan, Italy, from 2005 to 2015.
Interventions: LE procedures were performed in the electrophysiology laboratories with a cardiac operating room on standby between the end of the morning surgical case and before the start of the afternoon surgical case. Most procedures were conducted with the patient under procedural sedation and analgesia. After LE, patients were admitted either to the ward or to the ICU. Medical history and intraprocedural data were recorded.
Measurements and Main Results: Of the 389 procedures performed during the study period, 50 patients (13%) were admitted to the ICU owing to persistent hemodynamic instability or intraoperative complications requiring endotracheal intubation. Complete procedural success was achieved in 370 patients (95%), and the clinical success rate was 98.4%. No deaths were recorded. Five complications requiring emergency surgery (1.3%) were reported. Preprocedural right ventricular dysfunction (odds ratio (OR) 7.41; confidence interval 1.85-29.7; p < 0.01) and the need for general anesthesia (OR 12; confidence interval 1.49-97.06; p = 0.019) were independent predictors of ICU admission.
Conclusions: Preoperative identification of patients who need ICU admission after LE is crucial to increase patient safety and decrease hospital costs. Severe right ventricular dysfunction and need for general anesthesia identify patients with low cardiac reserve who are at increased risk for ICU admission after the procedure.
(Copyright © 2019 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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