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European Journal of Cardio-Thoracic Surgery, Vol 7, 313-318, Copyright © 1993 by European Association for Cardio-thoracic Surgery
S Westaby, R Pillai, A Parry, D O'Regan, N Giannopoulos, K Grebenik, M Sinclair and A Fisher
We considered that, with modern perfusion equipment and mildly hypothermic
cardiopulmonary bypass, protracted post-operative ventilation in an
intensive care unit (ITU) is no longer required after most cardiac
operations. We used a three-bedded cardiac recovery area (CRA) within the
operating suite for 1,000 patients between January 1990 and June 1991.
Forty-five patients with special needs were managed in the ITU. The time to
extubation (T50%; range) for coronary bypass, aortic valve, mitral valve,
and double-valve patients was 2.0 (0-42), 2.5 (0-12), 3.0 (0-15), and 3.0
(1-36) hours, respectively. Recovery beds were re-used allowing 5-6
operations daily. The difference in nursing staff complement for a CRA
versus ITU bed was 4.5/7.8. Patient management was by nurse specialists
supported by cardiac surgeons. Intervention by cardiac anaesthetists or
intensivists was limited to specific ventilatory problems or renal failure.
The early extubation policy failed in ten patients (five coronary, three
aortic, one mitral and one double-valve patient) through poor pre-operative
respiratory function, left ventricular failure or intra-operative events.
The overall mortality in CRA was 1.4%. The mean duration of post-operative
stay was 7 days (range 5-12). We conclude that a CRA staffed by nurse
practitioners provides a safe and effective alternative to the
anaesthetist-managed ITU. A rapid turnover of CRA beds removes the
constraints of ITU bed availability.
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