Does the full-time presence of an intensivist lead to better outcomes in the cardiac surgical intensive care unit?
| Autor: | Mathieu Simon, Steve Blackburn, Dimitri Kalavrouziotis, Stephane Langevin, Marc-Antoine Tardif, Ying Tung Sia, Siamak Mohammadi, Jed Lipes, Pascal Huard |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine Canada medicine.medical_specialty Critical Care medicine.medical_treatment Personnel Staffing and Scheduling Intensivist 030204 cardiovascular system & hematology Group B law.invention Cohort Studies 03 medical and health sciences 0302 clinical medicine Interquartile range law Medical Staff Hospital Humans Medicine Hospital Mortality Cardiac Surgical Procedures Mechanical ventilation business.industry EuroSCORE Length of Stay Middle Aged Intensive care unit Cardiac surgery Intensive Care Units 030228 respiratory system Cardiovascular Diseases Emergency medicine Propensity score matching Female Surgery Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Journal of Thoracic and Cardiovascular Surgery. 159:1363-1375.e7 |
| ISSN: | 0022-5223 |
| DOI: | 10.1016/j.jtcvs.2019.03.124 |
| Popis: | The study objective was to compare clinical outcomes in a dedicated adult cardiac surgery intensive care unit before and after the implementation of 24-hour intensivist coverage.Between 2008 and 2016, 16,454 consecutive adult patients were admitted to the cardiac surgery intensive care unit after cardiac surgery. During this period, postoperative patients in the cardiac surgery intensive care unit were managed by intensivists during the day (group A); in July 2010, the nighttime coverage was transferred from the hands of residents and fellows to intensivists (group B). Postoperative outcomes before and after this change using 1-to-1 propensity score matching were examined. Patients were stratified a priori into low- and high-risk (5% and ≥5% predicted mortality) based on the European System for Cardiac Operative Risk Evaluation II.Matched patients in group A had significantly higher cardiac surgery intensive care unit (2.1% vs 1.4%, P = .01) and in-hospital (2.7% vs 1.8%, P = .008) mortality. This higher mortality was only observed among high-risk group A patients who had significantly higher rates of cardiac surgery intensive care unit mortality (6.8% vs 4.1%, P = .01) and in-hospital mortality (8.5% vs 5.3%, P = .01) compared with the high-risk group B. The median duration of mechanical ventilation (5.8 vs 4.3 hours, P .0001) and the risk of prolonged ventilation greater than 48 hours (5.3% vs 4%, P = .008) were significantly higher among group A patients; this higher rate of respiratory adverse events was observed in all strata of preoperative risk.In this large cohort of patients admitted to a dedicated adult cardiac surgery intensive care unit, 24-hour intensivist coverage was associated with reduced mortality among patients with an expected operative mortality 5% or greater. These data suggest that preoperative risk stratification and adaptive cardiac surgery intensive care unit physician staffing may result in improved clinical outcomes and optimized hospital resource use. |
| Databáze: | OpenAIRE |
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