Evaluation of two intensive care models in relation to successful extubation after cardiac surgery

OBJECTIVE

To compare outcomes between intensivist-directed and cardiac surgeon-directed care delivery models.

DESIGN

This retrospective, historical-control study was performed in a cohort of adult cardiac surgical patients at Zhongshan Hospital (Fudan University, China). During the first phase (March to August 2015), cardiac surgeons were in charge of postoperative care while intensivists were in charge during the second phase (September 2015-June 2016). Both phases were compared regarding successful extubation rate, intensive care unit (ICU) length of stay (LOS), and in-hospital mortality.

SETTING

Tertiary Zhongshan Hospital (Fudan University, China).

PATIENTS

Consecutive adult patients admitted to the cardiac surgical ICU (CSICU) after heart surgery.

INTERVENTIONS

Phase I patients treated by cardiac surgeons, and phase II patients treated by intensivists.

MAIN VARIABLES OF INTEREST

Successful extubation, ICU LOS and in-hospital mortality.

RESULTS

A total of 1792 (phase I) and 3007 patients (phase II) were enrolled. Most variables did not differ significantly between the two phases. However, patients in phase II had a higher successful extubation rate (99.17% vs. 98.55%; p=0.043) and a shorter median duration of mechanical ventilation (MV) (18 vs. 19h; p<0.001). In relation to patients with MV duration >48h, those in phase II had a comparatively higher successful extubation rate (p=0.033), shorter ICU LOS (p=0.038) and a significant decrease in in-hospital mortality (p=0.039).

CONCLUSIONS

The intensivist-directed care model showed improved rates of successful extubation and shorter MV durations after cardiac surgery.