AI Summary & Key Takeaways
AI InsightCONCLUSION: Approaches for decreasing duration of intubation, intensive care unit stay and hospitalization may be applied in elective and uncomplicated cardiac surgical interventions with short duration of aortic cross-clamping and cardiopulmonary bypass, without risking patients.
📌 3 Key Takeaways
Abstract
AIM: 'Accelerated recovery' approach involving early extubation, early mobilization, decreased duration of intensive care unit stay and decreased duration of hospitalization has recently been a current and controversial issue in cardiac surgery. MATERIAL AND METHODS: We investigated timing of extubation, intensive care unit stay and duration of hospitalization in 225 consecutive cardiac surgery patients. Hunderdthirtynine were male and 86 were female; average age was 49.73±16.95 years. Coronary artery bypass grafting was performed in 127 patients, whereas in 65 patients aortic and/or mitral or pulmonary valvular operations, in 5 patients valvular plus coronary artery operations and in 28 patients surgical interventions for congenital anomalies were done. RESULTS: 'Accelerated recovery' approach could be applied in 169 of 225 patients (75.11%). 'Accelerated recovery' patients were extubated after average 3.97±1.59 hours and average duration of intensive care unit stay was 20.93±2.44 hours for these patients. Cases were discharged if they meet all of the following criteria: hemodynamically stabile, cooperated, able to initialize walking exercises within wards, no pathology in laboratory investigations and psychologically ready for discharge. Mean duration of hospitalization for 'accelerated recovery' patients was 4.24±0.75 days. Two patients required reintubation (1.18%). Four cases (2.36%) that were sent to the wards returned to intensive care unit and six patients (3.55%) were re-hospitalized. CONCLUSION: Approaches for decreasing duration of intubation, intensive care unit stay and hospitalization may be applied in elective and uncomplicated cardiac surgical interventions with short duration of aortic cross-clamping and cardiopulmonary bypass, without risking patients.
Özet
AMAÇ: Kardiyak cerrahide erken ekstübasyon, erken mobilizasyon, yoğun bakımda ve hastanede kalış sürelerinin azaltılmasını kapsayan 'hızlandırılmış iyileşme' uygulaması son yıllarda gündemde olan ve tartışılan bir konudur. GEREÇ VE YÖNTEM: Merkezimizde, kardiyak cerrahi uyguladığımız ardışık 225 hastada entübasyon zamanını, yoğun bakımda ve hastanede kalış sürelerini inceledik. İkiyüzyirmibeş hastanın 139'u erkek ve 86'sı kadın iken, ortalama yaş 49.73±16.95 olarak saptandı. Yüzyirmiyedi hastada koroner arter baypas greft, 65 hastada aort ve/veya mitral ve pulmoner kapak operasyonu, 5 hastada kapak + koroner operasyonu ve 28 hastada ise konjenital cerrahi girişim uygulandı. BULGULAR: İkiyüzyirmibeş hastanın 169'unda 'hızlandırılmış iyileşme' yaklaşımı uygulanabildi (%75.11). Bu hastalar ortalama 3.97±1.59 saatte ekstübe edildiler ve 20.93±2.44 saatte yoğun bakımdan servise verildiler. Hemodinamik olarak stabil, koopere, günlük yürüyüşlere başlayan, laboratuar incelemelerinde patoloji bulunmayan ve psikolojik olarak kendini hazır hisseden hastalar ortalama 4.24±0.75 gün taburcu edildiler. Altı saat içinde ekstübe ettiğimiz hastaların 2'si reentübe oldu (%1.18). Servise verilen hastaların 4'ü yoğun bakıma geri alınırken (%2.36), taburcu edilen hastalardan 6'sı rehospitalize edildi (%3.55). SONUÇ: Entübasyon zamanını, yoğun bakımda ve hastanede kalış süresini azaltma konusundaki yaklaşımlar; elektif, komplike olmayan ve aortik kros-klemp ve kardiyopulmoner baypas süreleri kısa olan kardiyak cerrahi operasyonlarında, hastaların sağlık durumundan ödün vermeden başarıyla uygulanabilir.