Title

Influence Of A Dedicated Paediatric Cardiac Intensive Care Unit On Patient Outcomes

Keywords

Paediatric cardiac intensive care; Paediatric intensive/critical care

Abstract

Background: The impact of a designated intensive care unit (ICU) for postoperative cardiac care in children is not clear. In our hospital (in the USA), we started a new Paediatric Cardiac Surgery programme 5 years ago, in September 2004. During the first 2 years of the programme, postoperative care was accomplished within the general paediatric ICU (PICU or c-ICU). Subsequently, in September 2006, a dedicated cardiac ICU (d-ICU) was established. We looked at our experience during these two periods to determine whether the designation of a separate ICU affected outcomes for these children. Design and Methods: We obtained Institutional Review Board (IRB) approval to review the medical records for all postoperative cardiac admissions to the ICU during the first 4 years of the programme (September 2004–September 2008). Variables collected included age, gender, diagnosis, type of cardiac surgery, Risk Adjustment for Congenital Cardiac Surgery, version 1 (RACHS-1) classification, ventilator use, hospital stay, invasive line infections, ventilator-related infections, wound infections, need for cardiopulmonary support, return to the operating room, re-exploration of the chest, delayed sternal closure, accidental extubations, re-intubation and mortality rates. These variables were summed and compared for the combined PICU and the dedicated paediatric cardiac ICU. Results: There were 199 cases performed in the first 2 years compared with 244 in the following 2 years. We saw a statistically insignificant increase in the number and complexity of cases during the second period (p = 0·08). However, morbidity declined as evidenced by the decrease in wound infection (p < 0·001) and need for chest re-exploration (p < 0·001). In addition, mortality declined from 7 of 199 (3·5%)to2of 244 (0·8%). p < 0·04 and less children required resuscitation (p < 0·01). Conclusions: We believe the designation of a specific area for postoperative cardiac care was instrumental in the growth and development of our cardiac programme. This rapid change accomplished several crucial elements that lead to accelerated improvement in patient care and a decline in morbidity and mortality.

Publication Date

11-1-2011

Publication Title

Nursing in Critical Care

Volume

16

Issue

6

Number of Pages

281-286

Document Type

Article

Personal Identifier

scopus

DOI Link

https://doi.org/10.1111/j.1478-5153.2011.00455.x

Socpus ID

84856598642 (Scopus)

Source API URL

https://api.elsevier.com/content/abstract/scopus_id/84856598642

This document is currently not available here.

Share

COinS