Surgery in the Cardiovascular Surgical Intensive Care Unit

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• 作者：Juan Fernando Encalada ; Paula Campelos ; Cristian Delgado ; Guillermo Ventosa ; Eduard Quintana ; Elena Sandoval ; Daniel Pereda ; Ramó ; n Cartaňá ; Salvador Ninot ; Clemente Barriuso ; Miguel Josa ; Manuel Castellá ; José ; Luis Pomar ; Jaime Mulet ; Carlos-Alberto Mestres ; ^{cmestres@clinic.ub.es" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Surgery ; Cardiac ; Intensive care ; Operation
• 刊名：Cirugía Española (English Edition)
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：94
• 期：4
• 页码：227-231
• 全文大小：312 K

文摘

To analyse the indications, actions and results of the operations performed in the Cardiovascular Surgery Intensive Care Unit.

Methods

Retrospective analysis of consecutive non-selected adult patients operated in the ICU, with descriptive statistics. All operations performed were included.

Results

Between 2008 and 2013, 3379 consecutive adult patients were operated upon. A total of 124 operations were performed in the ICU in 109 patients 70 male (64.2%) and 39 female (35.8%), with a mean age of 61.6 years (12–80). This represented 3.2% of all operations. During the study period, 185 patients (5.5%) were reoperated for postoperative bleeding/cardiac tamponade in the operating room. Previous interventions were for valvular heart disease (34.9%), aortic disease (22.9%), ischaemic heart disease (15.6%), combined valvular/ischaemic (12%), valvular/aorta (11%) and miscellaneous (3.6%). The indications for reoperation were: persistent bleeding 54 (43.5%), pericardial tamponade 41 (33%), low cardiac output 13 (10.5%), cardiac arrest/arrhythmia 8 (6.5%), respiratory insufficiency 6 (4.8%) and acute ischaemic limb 2 (1.7%). Operations performed were: mediastinal exploration 73 (58.9%), implant/removal of ECMO 17 (13.7%), sternal closure 16 (12.9%), open resuscitation 9 (7.3%), subxiphoid drainage 7 (5.6%) and femoral embolectomy 2 (1.6%). Overall mortality was 33%. There was one case of mediastinitis 0.9%, with no difference from patients operated in the regular operating room.

Conclusions

Operations in the ICU represent a safe, life-saving alternative in specific subgroups of patients. The risk of wound infection is not increased, unstable patients are not transferred and there is time savings.